急性胰腺炎并发脾脏受累诊治分析OA

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.