腹部手术后伴发Wernicke脑病诊治分析

 目的 探讨腹部手术后伴发Wernicke脑病的临床特点,以早期诊断及治疗,减少误诊误治。方法 回顾解放军309医院肝胆外科2006-09至2017-10收治的10例腹部外科手术伴发Wernicke脑病患者临床资料,总结其临床表现、辅助检查及治疗情况,分析误诊原因。结果 本组10例腹部外科手术后出现吻合口漏、粘连性肠梗阻、腹腔感染等并发症,其中每例患者至少合并1种并发症,治疗要求短时间内不能正常经口进食,病程均在3周以上。临床表现主要有精神异常8例,共济失调6例,眼球震动4例,认知功能减退5例。10例早期全部误诊,后经多科室会诊后确诊,给予大剂量维生素B₁治疗,6例痊愈,由于治疗不及时,3例留下后遗症状,死亡1例。结论 腹部手术后伴发Wernicke脑病症状不典型,应加强对该病的早期诊断及治疗,维生素B₁治疗效果显著。

Diagnosis and treatment of Wernicke encephalopathy secondary to abdominal surgery

Objective To investigate the clinical features of Wernicke encephalopathy after abdominal surgery in order to enable early diagnosis and treatment while reducing cases of misdiagnosis and mistreatment.Methods The clinical data of 10 patients with Wernicke encephalopathy after abdominal surgery treated in our department between September 2006 and October 2017 was reviewed.The clinical manifestations, auxiliary examination and treatment were summarized,and the causes of misdiagnosis were analyzed.Results All the ten patients underwent severe postoperative complications,such as anastomotic leakage,intestinal obstruction and abdominal infection.Each of them had at least two complications that made it impossible for them to eat through the mouth for more than three weeks.The clinical manifestations included mental disorder (8 cases),cerebellar dysfunction(6 cases),eye signs(4 cases), and cognitive dysfunction(5 cases).These ten cases were all misdiagnosed at first,but confirmed later after consultation by several departments.After treatment with vitamin B₁, 6 cases were cured.Squelae occurred in 3 cases because of the delay of treatment. There was one death.Conclusions Due to the atypical symptoms of Wernicke encephalopathy after abdominal surgery, early diagnosis and treatment of the disease are recommended.