Wang Rong, Zhu Jun-Ming, Qi Rui-Dong, Liu Yong-Min, Zheng Jun, Zhang Nan, Sun Li-Zhong
Department of Anesthesiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases and Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases and Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Ann Vasc Surg. 2018 Oct;52:85-89. doi: 10.1016/j.avsg.2018.03.007. Epub 2018 May 17.
Acute ischemic pancreatitis secondary to aortic dissection is very rare with an unclarified mechanism. We retrospectively reviewed 6 such cases in our center and present their outcomes herein.
Between February 2009 and April 2017, 6 patients (male = 2 and female = 4; mean age, 58 ± 8 years [range, 47-70 years]) with acute aortic dissection associated with pancreatitis were admitted to our center. There were 3 type A and 3 type B dissections. One patient developed renal dysfunction and visceral organ ischemia, and 1 developed renal failure and ischemia of the lower extremity. Five patients had a history of hypertension, and 1 had diabetes mellitus.
After aggressive medical treatment, 5 patients survived the acute phase of aortic dissection and acute ischemic pancreatitis. Surgery was required in 4 patients and thoracic endovascular aortic repair in 1 patient. There were no severe postoperative complications, and all 5 were discharged. One patient with acute type B dissection refused treatment and died from multiple organ failure. No complications or deaths occurred in the postoperative follow-up period.
Acute ischemic pancreatitis after aortic dissection is a very unusual complication. The potential for this concomitant diagnosis should always be considered during the diagnostic stages. There is no clear consensus regarding the management of aortic dissection associated with acute pancreatitis.
主动脉夹层继发急性缺血性胰腺炎非常罕见，其机制尚不清楚。我们回顾性分析了本中心6例此类病例，并在此介绍其治疗结果。
2009年2月至2017年4月，6例（男性2例，女性4例；平均年龄58±8岁[范围47 - 70岁]）伴有胰腺炎的急性主动脉夹层患者入住本中心。其中3例为A型夹层，3例为B型夹层。1例患者出现肾功能不全和内脏器官缺血，1例出现肾衰竭和下肢缺血。5例患者有高血压病史，1例有糖尿病史。
经过积极的药物治疗，5例患者在主动脉夹层急性期和急性缺血性胰腺炎中存活。4例患者需要手术治疗，1例患者接受了胸主动脉腔内修复术。术后无严重并发症，5例均出院。1例急性B型夹层患者拒绝治疗，死于多器官功能衰竭。术后随访期间无并发症或死亡发生。
主动脉夹层后急性缺血性胰腺炎是一种非常罕见的并发症。在诊断阶段应始终考虑这种伴随诊断的可能性。对于主动脉夹层合并急性胰腺炎的治疗，目前尚无明确的共识。
