探讨胰十二指肠切除术后胰管支架管致肝脓肿的病因及诊治特点。

回顾性分析2022年4月10日上海孟超肿瘤医院收治的1例胰十二指肠切除术后胰管支架管致肝脓肿患者临床资料。患者女，61岁，已签署知情同意书，符合伦理学规定。分析并复习相关文献病例的临床资料，包括病史、诊治经过及预后随访等，总结此罕见病的诊治特点。

患者因"胰腺癌胰十二指肠切除术后20 d，间断寒战、发热2 d"收入院。入院后检测：WBC 8.5×10⁹/L，C-反应蛋白120 mg/L，TB 33 μmol/L，DB 23 μmol/L，ALT 47 U/L，血淀粉酶971 U/L。上腹部CT示肝右后叶下段异常密度影，考虑肝脓肿；胰腺管走行区见引流管影，其外引流端与肝内病变相连，考虑内置胰管支架管刺穿肠管，刺入肝脏形成肝脓肿。遂行肝脓肿穿刺置管引流术。术后给予抗细菌和真菌感染、抑酸、补液、营养支持、补充白蛋白等对症治疗，复查CT示肝脓肿引流后病灶较前缩小。患者病情稳定，恢复顺利出院。患者后期复查无异常，予拔除肝脓肿引流管、T管、空肠营养管，患者恢复顺利。

胰管支架管刺破肠腔，刺入肝脏引起肝脓肿是一类罕见的术后并发症，影像学检查是确诊此类疾病的主要方式，应尽早诊断，及时充分引流，防止胰液对周围组织更大的损害及出现危及生命的并发症。

To investigate the etiology, diagnosis and treatment of liver abscess caused by pancreatic duct stent after pancreatoduodenectomy.

Clinical data of a 61-year-old female patient diagnosed with liver abscess caused by pancreatic duct stent after pancreaticoduodenectomy admitted to Shanghai University Mengchao Cancer Hospital on April 10, 2022 were retrospectively analyzed. The informed consent of this patient was obtained and the local ethical committee approval was received. Literature review was conducted and clinical data including medical history, diagnosis, treatment, prognosis and follow-up were analyzed. The characteristics of diagnosis and treatment of such rare disease were summarized.

The patient was admitted to our hospital due to "intermittent chills and fever for 2 d at 20 d after pancreaticoduodenectomy". Testing results after admission: WBC 8.5×10⁹/L, C-reactive protein 120 mg/L, TB 33 μmol/L, DB 23 μmol/L, ALT 47 U/L and serum amylase level 971 U/L. Upper abdominal CT scan showed abnormal density shadow in the lower segment of right posterior lobe, and the possibility of liver abscess was considered. A drainage tube shadow was observed in the branching area of pancreatic duct, and the external end was connected with the lesions in the liver. It was considered that the placed pancreatic duct stent penetrated into the gut and liver, forming a liver abscess. Therefore, puncture and drainage of liver abscess were performed. Symptomatic treatments including anti-bacterial and fungus infection, acid suppression, fluid replacement, nutritional support and albumin supplementation were delivered after surgery. Repeat CT scan showed that the liver abscess was smaller after drainage. The patient was physically stable and discharged after proper recovery. No abnormality was reported in subsequent examinations. The drainage tube of the liver abscess, T tube and jejunal nutrition tube were removed, and the patient was successfully recovered.

Liver abscess, caused by the invasion of pancreatic duct stent into the gut and liver, is a rare postoperative complication. Imaging examination is the main diagnostic tool. Early diagnosis and timely drainage should be performed to prevent the incidence of severe injury to the surrounding tissues caused by pancreatic juice and even life-threatening complications.