2026年 · 第64卷第08期

The patient, an 18-year-old male, was transferred from a local hospital to our hospital's pancreatic disease diagnosis and treatment center on December 22, 2024, due to "severe acute pancreatitis (SAP) that had been ongoing for 2 days". After eating barbecue 2 days ago, the patient developed abdominal pain, which was persistent dull pain, limited to the upper abdomen, accompanied by radiating pain in the lower back and persistent fever, with a maximum body temperature of 38.7 ℃, accompanied by nausea and vomiting. The vomit was gastric contents, and the pain was not significantly relieved after vomiting. There was no diarrhea, constipation, black stool, jaundice, fatigue, emaciation, etc. After performing abdominal CT scan and other related examinations in another hospital, the patient was immediately admitted to the ICU, opened a large-diameter blood purification pathway, performed blood purification twice, and left a pelvic puncture drainage tube. Due to the aggravation of the condition, he was transferred to the pancreatic center ICU of our hospital for further treatment. The patient had a 4-year history of diabetes mellitus, daily insulin therapy, and a 1-year history of hyperlipidemia, without medication. He denied a history of surgical trauma, alcohol consumption, drug allergies, and family medical history. Physical examination: body temperature 38.5 ℃, heart rate 98 beats/min, respiratory rate 22 beats/min, blood pressure 134/86 mmHg (1 mmHg=0.133 kPa), general poor condition, conscious, acute illness, no yellowing of the skin and sclera, abdominal distension, one pelvic drainage tube visible, draining brownish drainage fluid, no gastrointestinal type or peristaltic wave, no mass palpation, positive upper abdominal tenderness with abdominal muscle tension, positive mobile voice, and one large-diameter catheter of the right inguinal femoral vein. Laboratory test: White blood cell count 9.85 × 10⁹/L, neutrophil percentage 78.6%, red blood cell count 2.98 × 10¹²/L, hemoglobin 83 g/L; Total bilirubin 18.4 μmol/L, ALT 80.7 U/L, AST 222.9 U/L, albumin 20.8 g/L, Ca²⁺0.78 mmol/L, creatinine 375.8 μmol/L, glucose 14.39 mmol/L, triglycerides 7.3 mmol/L; C-reactive protein 141.95 mg/L; Procalcitonin 84.86 μg/L; IL-6 105.6 pg/ml. Imaging examination: The results of whole abdominal CT examination showed decreased liver parenchyma density, thickened pancreas, rough edges, irregular fluid density shadows and striped shadows were visible in the omental sac, peripancreatic space, perispleen space, bilateral paracolonic sulcus, and bilateral pararenal space, which changed after pelvic catheterization (Figure 1A~1C). CT examination of the lungs revealed inflammation in the lower lobes of both lungs and bilateral pleural effusion. Based on the patient's medical history, physical examination and auxiliary examinations, the preliminary diagnosis was SAP, pancreatic necrosis, peripancreatic effusion, abdominal compartment syndrome, systemic inflammatory response syndrome, moderate anemia, pneumonia, bilateral pleural effusion, ascites, acute renal failure, fatty liver, type 1 diabetes, hyperlipidemia and hypoproteinemia.

Almost every surgeon has a copy of Huang Jiasi Surgery on his desk in his medical career. The book was first published in 1960 as Surgery; From the 4th edition in 1986, in honor of the founder of this book, Professor Huang Jiasi, it was renamed "Huang Jiasi Surgery". I was very fortunate to participate in the compilation of the sixth edition of Huang Jiasi Surgery in 2000, and thus witnessed with my own eyes the whole process of my teacher, Academician Qiu Fazu, who was then the editor-in-chief of this book, from overall organization to word-for-word proofreading.