肝胆胰外科杂志2026，Vol.38Issue(5)：346-352,7.DOI:10.11952/j.issn.1007-1954.2026.05.007
急性胰腺炎并发脾脏受累诊治分析
Diagnosis and treatment of splenic involvement secondary to acute pancreatitis
摘要
Abstract
Objective To summarize the stratified diagnostic and therapeutic strategy of patients with acute pancreatitis(AP)complicated by splenic involvement.Methods The clinical data of 11 patients with AP complicated by splenic involvement who were admitted to the People's Hospital of Wenshan prefecture and Maguan County People's Hospital between January 2023 and May 2025 were retrospectively analyzed.Results All 11 patients were male,with a median age of 47(35,51)years.On admission,the median serum amylase level was 426.0(234.5,1 253.5)U/L,and the median hemoglobin level was 92.0(77.5,107.0)g/L.Three patients were managed conservatively,and follow-up imaging demonstrated lesion regression.One patient with a splenic abscess underwent ultrasound-guided percutaneous catheter drainage,achieving infection control.Seven patients developed splenic rupture:2 patients underwent splenectomy,of which 1 patient developed enlargement of a pseudocyst in the pancreatic tail 4 months postoperatively and subsequently underwent cystogastrostomy;the remaining 5 patients underwent emergency distal pancreatectomy(body and tail)with splenectomy(2 laparoscopic,3 open),of which 1 patient had a concomitant splenic artery pseudoaneurysm and gastric and colonic perforation and underwent gastrostomy and colostomy.Conclusion Management of AP complicated by splenic involvement should be stratified based on clinical presentation and imaging findings,particularly contrast-enhanced CT or computed tomography angiography(CTA).Mild lesions may be managed conservatively with close follow-up.Infectious lesions should be treated early with image-guided aspiration/catheter drainage combined with antimicrobial therapy.Patients with hemorrhage,pseudoaneurysm,or splenic rupture require urgent endovascular embolization or surgical intervention to reduce the risk of fatal events.Anticoagulation strategies for splanchnic vein thrombosis must be individualized and determined through multidisciplinary team(MDT)assessment.关键词
急性胰腺炎/脾脏受累/脾静脉血栓/脾假性动脉瘤/并发症/分层处理Key words
acute pancreatitis/splenic involvement/splenic vein thrombosis/splenic pseudoaneurysm/complications/stratified management分类
医药卫生引用本文复制引用
何腾俊,何雪鹏,李佳佳,骆聪,陆志刚,王树锋,田庆禄,王永生..急性胰腺炎并发脾脏受累诊治分析[J].肝胆胰外科杂志,2026,38(5):346-352,7.基金项目
文山州"兴文英才计划"人才培养专项——"名医项目"(WS-MY0077). （WS-MY0077）
