【摘要】：目的:回顧分析胰腺疾病(急性胰腺炎、慢性胰腺炎、胰腺癌)的臨床病例資料,研究它們糖代謝紊亂及臨床特點,進(jìn)一步指導(dǎo)臨床治療。方法:收集2012年1月-2014年12月在皖南醫(yī)學(xué)院第一附屬醫(yī)院收住的胰腺疾病患者,其中76例輕度急性胰腺炎(mild acute pancreatitis,MAP),46例中度重癥急性胰腺炎(moderately severe acute pancreatitis,MSAP),27例重癥急性胰腺炎(severe acute pancreatitis,SAP),28例慢性胰腺炎(chronic pancreatitis,CP),157例胰腺癌(pancreatic carcinoma,PC),總結(jié)各組一般情況、臨床表現(xiàn)、血糖變化等資料。結(jié)果:76例MAP患者,平均年齡53.2歲,伴有膽囊結(jié)石或膽總管結(jié)石或二者兼有者約占65.8%;腹痛患者100%;伴惡心嘔吐患者約占82.9%;伴腰背部放射痛患者約占40.8%,入院空腹血糖平均為7.87mmol/L,住院期間血糖平均為7.25mmol/L,出院前血糖平均為6.29mmol/L,入院查白細(xì)胞平均為11.0*1012/L;低鈣血癥患者約占13.2%;無低蛋白血癥患者,沒有發(fā)生局部并發(fā)癥和全身并發(fā)癥;46例MSAP患者,平均年齡51.4歲,伴有膽囊結(jié)石或膽總管結(jié)石或二者兼有者約占58.7%;腹痛患者占100%;伴惡心嘔吐患者約占91.3%;伴腰背部放射痛患者約占43.5%,其血糖觀察指標(biāo)分別是9.58mmol/L、7.69mmol/L、7.14mmol/L,入院查白細(xì)胞平均為13.5*1012/L;低鈣血癥患者約占13.0%;低蛋白血癥患者約占47.8%,并發(fā)假性囊腫者約為13.0%;伴胸腹水者約為84.8%;沒有并發(fā)胰腺膿腫患者;并發(fā)急性肺損傷(acute lung injury,ALl)/急性呼吸窘迫綜合征(acute respiratory distress syndrome,ARDS)者約占2.2%;并發(fā)急性腎衰竭(acute renal failure,ARF)者約占2.2%;27例SAP患者,平均年齡51.1歲,伴有膽囊結(jié)石或膽總管結(jié)石或二者兼有者約占44.4%;腹痛患者占100%;伴惡心嘔吐患者約占96.3%;伴腰背部放射痛患者約占59.3%,其血糖觀察指標(biāo)分別是11.8mmol/L、9.63mmol/L、8.98mmol/L,入院查白細(xì)胞平均為15.5*1012/L;低鈣血癥患者約占29.6%;低蛋白血癥患者約占88.9%,并發(fā)假性囊腫者約為63.0%;伴胸腹水者約為96.3%;并發(fā)胰腺膿腫者約占7.4%;并發(fā)ALl/ARDS者約占29.6%;并發(fā)ARF者約占14.8%。28例CP患者,平均年齡為61.1歲,飲酒病史者約占39.3%,有膽系疾病病史者約占39.3%,有AP病史者占25%,腹痛患者約占78.6%;腹瀉患者約占17.9%,消瘦患者約占10.7%;納差患者約占10.7%;餐后上腹飽脹患者約占3.6%,空腹血糖高于6.1mmol/L者約占39.3%,有糖尿病病史患者6例。157例PC患者,好發(fā)于老年患者,平均發(fā)病年齡為64.1歲,腹痛患者82%,消瘦患者87.2%,黃疸患者占36.9%,大量腹水患者3%;腹瀉患者6%,有糖尿病病史患者其空腹血糖平均為9.12mmol/L,無糖尿病病史患者其空腹血糖平均為6.00mmol/L,糖尿病病史3年以內(nèi)者有16例,3年以上或病史年限不詳?shù)臑?4例,發(fā)現(xiàn)有轉(zhuǎn)移的患者占80.9%,未發(fā)現(xiàn)轉(zhuǎn)移的患者占19.1%;胰頭癌患者占64.3%,胰體尾癌患者占35.7%。結(jié)論:1,AP時,血糖異常升高,在一定程度上可以反映病情嚴(yán)重程度;2,膽囊結(jié)石或膽總管結(jié)石是AP最主要的病因;腹痛是最常見的臨床表現(xiàn);SAP時常常出現(xiàn)全身并發(fā)癥;3,隨著病程進(jìn)展,CP后期可出現(xiàn)糖耐量異常和糖尿病;4,腹痛是CP最突出的癥狀,也可出現(xiàn)腹瀉、納差、消瘦等臨床表現(xiàn);5,新發(fā)糖尿病有助于PC的早期診斷;6,PC好發(fā)于老年患者,可有腹痛、腹瀉、消瘦、黃疸等表現(xiàn),且轉(zhuǎn)移較早。
[Abstract]:Objective: to retrospectively analyze the clinical data of pancreatic diseases (acute pancreatitis, chronic pancreatitis, pancreatic cancer), study their glucose metabolism disorders and clinical characteristics, and further guide clinical treatment. methods: 76 patients with pancreatic diseases admitted to the First Affiliated Hospital of Southern Anhui Medical College from January 2012 to December 2014 were collected. Mild acute pancreatitis (MAP), 46 moderately severe acute pancreatitis (MSAP), 27 severe acute pancreatitis (SAP), 28 chronic pancreatitis (CP), and 157 pancreatic carcinoma (PC). The general conditions, clinical manifestations, blood glucose levels of each group were summarized. Results: The average age of 76 patients with MAP was 53.2 years old, with cholecystolithiasis or choledocholithiasis or both accounting for 65.8%; abdominal pain 100%; nausea and vomiting 82.9%; low back radiation pain 40.8%; admission fasting blood glucose 7.87 mmol/L, average blood glucose 7.25 mmol/L during hospitalization, before discharge The average blood glucose was 6.29 mmol/L, and the average leukocyte count was 11.0*1012/L on admission; 13.2% of the patients with hypocalcemia; no hypoalbuminemia, no local complications and systemic complications; 46 patients with MSAP, with an average age of 51.4 years, with cholecystolithiasis or choledocholithiasis or both accounted for 58.7%; 100% with abdominal pain; and 100% with nausea; Vomiting accounted for 91.3%; low back radiation pain accounted for 43.5%; blood glucose was 9.58 mmol/L, 7.69mmol/L, 7.14 mmol/L, and the average white blood cell was 13.5*1012/L; hypocalcemia accounted for 13.0%; hypoalbuminemia accounted for 47.8%; pseudocyst accounted for 13.0%; hydrothorax and ascites accounted for 84.8%; no and no leukocyte. Pancreatic abscess; acute lung injury (ALl) / acute respiratory distress syndrome (ARDS) accounted for 2.2%; acute renal failure (ARF) accounted for 2.2%; 27 SAP patients, average age 51.1 years, with gallstones or common bile duct stones or both About 44.4%; abdominal pain accounted for 100%; nausea and vomiting accounted for 96.3%; low back radiation pain accounted for 59.3%; the blood glucose indexes were 11.8 mmol/L, 9.63 mmol/L, 8.98 mmol/L, and the average leukocyte count was 15.5*1012/L; hypocalcemia accounted for 29.6%; hypoalbuminemia accounted for 88.9%; and pseudocyst accounted for 63.9%. Among the 28 CP patients, the average age was 61.1 years old, the drinking history was 39.3%, the history of biliary diseases was 39.3%, the AP history was 25%, the abdominal pain was 78.6%, the diarrhea patients was 17.9%, and the emaciation patients were about 17.9%. 10.7%; 10.7%; 10.7%; 3.6% of the patients with postprandial fullness, 39.3% of the patients with fasting blood glucose higher than 6.1 mmol/L, and 6.157 patients with diabetes mellitus were PC patients. The average age of onset was 64.1 years old, 82% of the patients with abdominal pain, 87.2% of the patients with emaciation, 36.9% of the patients with jaundice, 3% of the patients with massive ascites, and 6% of the patients with diarrhea. The average fasting blood glucose was 9.12 mmol/L in patients with diabetes history, 6.00 mmol/L in patients without diabetes history, 16 patients with diabetes history less than 3 years, 14 patients with more than 3 years or unknown disease history, 80.9% patients with metastasis, 19.1% patients without metastasis, 64.3% patients with pancreatic head cancer and 64.3% patients with pancreatic body and tail cancer. Conclusion: 1. The abnormal increase of blood glucose during AP can reflect the severity of the disease to a certain extent; 2. Gallstone or choledocholithiasis is the main cause of AP; Abdominal pain is the most common clinical manifestation; Systemic complications often occur during SAP; 3. With the progress of the disease, abnormal glucose tolerance and diabetes mellitus may occur in the later stage of CP; 4. Abdominal pain is the most common cause of AP. The most prominent symptoms of CP can also appear diarrhea, poor appetite, emaciation and other clinical manifestations; 5, new-onset diabetes contributes to the early diagnosis of PC; 6, PC occurs in elderly patients, can have abdominal pain, diarrhea, emaciation, jaundice and other manifestations, and metastasis early.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R576

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