Tauchi Ryoji, Imagama Shiro, Ito Zenya, Ando Kei, Hirano Kenichi, Ukai Junichi, Kobayashi Kazuyoshi, Shinjo Ryuichi, Muramoto Akio, Nakashima Hiroaki, Matsumoto Tomohiro, Ishiguro Naoki
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 4668550, Japan.
Eur J Orthop Surg Traumatol. 2014 Jul;24 Suppl 1:S305-9. doi: 10.1007/s00590-013-1390-z. Epub 2013 Dec 8.
Although acute postoperative pancreatitis is a relatively frequent complication after open biliary tract surgery and gastric surgery, acute pancreatitis after spine surgery is a rare complication. We report the first case of acute pancreatitis after posterior lumbar interbody fusion (PLIF) for spondylolisthesis that resolved with conservative treatment. A 53-year-old female patient received a PLIF from L3 to L5. The patient presented with persistent mild abdominal pain, nausea and vomiting several hours after the surgery. An abdominal CT revealed swelling of the head of the pancreas and free fluid around the pancreas. A gastroenterologist diagnosed acute pancreatitis and prescribed nafamostat mesilate, antibiotics and intravenous fluid therapy. The patient recovered gradually, and clinical symptoms disappeared. At 6 months after the operation, she had experienced no recurrence of abdominal symptoms, and solid spinal fusion was achieved. In previous studies, acute pancreatitis was reported as a complication after spine surgery for various spine diseases such as scoliosis and lumbar disorders. The procedures performed included anterior/posterior scoliosis surgery and anterior/posterior lumbar fusion surgery. We must consider the possibility of acute pancreatitis when unusual abdominal symptoms with elevated serum amylase levels occur after spine surgery. Prompt diagnosis and supportive therapy are essential to minimize morbidity and mortality.
尽管急性术后胰腺炎是开腹胆道手术和胃部手术后较为常见的并发症，但脊柱手术后的急性胰腺炎却是一种罕见的并发症。我们报告了首例因腰椎滑脱行后路腰椎椎间融合术（PLIF）后发生的急性胰腺炎，经保守治疗后痊愈。一名53岁女性患者接受了L3至L5的PLIF手术。术后数小时，患者出现持续性轻度腹痛、恶心和呕吐。腹部CT显示胰头肿胀，胰腺周围有游离液体。一名胃肠病学家诊断为急性胰腺炎，并开具了甲磺酸萘莫司他、抗生素和静脉输液治疗。患者逐渐康复，临床症状消失。术后6个月，她未出现腹部症状复发，且实现了牢固的脊柱融合。在先前的研究中，急性胰腺炎被报道为脊柱侧弯和腰椎疾病等各种脊柱疾病的脊柱手术后的并发症。所进行的手术包括前路/后路脊柱侧弯手术和前路/后路腰椎融合手术。当脊柱手术后出现异常腹部症状且血清淀粉酶水平升高时，我们必须考虑急性胰腺炎的可能性。及时诊断和支持治疗对于将发病率和死亡率降至最低至关重要。
