气肿型胰腺炎的分类及其与预后的关系

李嘉荣; 朱帅; 曹昕彤; 林嘉晏; 宁彩虹; 黄耿文

doi:10.11817/j.issn.1672-7347.2020.200678

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论著 | 更新时间：2022-05-10

气肿型胰腺炎的分类及其与预后的关系
Classification of emphysematous pancreatitis and its relation to prognosis
中南大学学报(医学版) 中南大学学报(医学版) 2020年45卷第11期页码：1348-1354
作者机构：

1.中南大学湘雅医院普通外科，长沙 410008
作者简介：

李嘉荣，Email: 30652004@qq.com, ORCID: 0000-0002-8763-8968
黄耿文，Email: gengwenhuang@qq.com, ORCID: 0000-0003-1426-8000
基金信息：

国家自然科学基金(81802450);湖南省自然科学基金(2020JJ4133);湖南省卫生健康委员会科研计划(B2019190);湖南省科技创新计划(2017SK50101)
DOI：10.11817/j.issn.1672-7347.2020.200678
中图分类号：
CSTR：

李嘉荣, 朱帅, 曹昕彤, 等. 气肿型胰腺炎的分类及其与预后的关系[J]. 中南大学学报(医学版), 2020,45(11):1348-1354.

Jiarong LI, Shuai ZHU, Xintong CAO, et al. Classification of emphysematous pancreatitis and its relation to prognosis[J]. Journal of Central South University. Medical Science, 2020,45(11):1348-1354.
李嘉荣, 朱帅, 曹昕彤, 等. 气肿型胰腺炎的分类及其与预后的关系[J]. 中南大学学报(医学版), 2020,45(11):1348-1354. DOI： 10.11817/j.issn.1672-7347.2020.200678.

Jiarong LI, Shuai ZHU, Xintong CAO, et al. Classification of emphysematous pancreatitis and its relation to prognosis[J]. Journal of Central South University. Medical Science, 2020,45(11):1348-1354. DOI： 10.11817/j.issn.1672-7347.2020.200678.

摘要

目的,2,气肿型胰腺炎(emphysematous pancreatitis，EP)是感染性胰腺坏死(infected pancreatic necrosis，IPN)的一种亚型，其特点是胰腺坏死组织内部或胰周有气体积聚。本研究探讨EP的分类与预后的关系，以期为临床诊治IPN提供指导。,方法,2,2010年1月至2020年6月间中南大学湘雅医院普通外科连续收治228例IPN患者，将其中在入院前未行外科干预的120例IPN患者纳入本研究，并分为EP组和非EP组，比较2组的一般临床资料和病原微生物检查结果。将EP患者根据气泡征出现的时间分为早期EP和后期EP患者；根据气泡征的分布范围分为广泛型EP和普通型EP患者。比较IPN死亡组与存活组，EP死亡组与存活组的临床特征。,结果,2,120例IPN患者中有EP患者25例(20.8%)和非EP患者95例(79.2%)。早期EP 8例(32.0%)，后期EP 17例(68.0%)；普通型EP 15例(60.0%)，广泛型EP 10例(40.0%)。EP组和非EP组性别、年龄、病因、病死率等的差异均无统计学意义(均,P,>,0.05)。EP组大肠埃希菌的感染率显著高于非EP组(52.0% vs 16.5%，,P,<,0.05)。120例IPN患者中35例死亡(IPN死亡组)，85例存活(IPN存活组)，IPN病死率为29.2%。IPN死亡组和IPN存活组性别、年龄、病因等的差异无统计学意义(均,P,>,0.05)。IPN死亡组重症患者占比明显高于IPN存活组(97.1% vs 54.1%，,P,<,0.05)。25例EP患者中8例死亡(EP死亡组)，17例存活(EP存活组)，EP病死率为32.0%。EP死亡组和EP存活组性别、年龄、病因、发现气体至外科干预的时间等的差异无统计学意义(均,P,>,0.05)。EP死亡组早期EP、广泛型EP占比均明显高于EP存活组，差异有统计学意义(均,P,<,0.05)。早期EP+广泛型EP患者病死率高达100%。EP死亡组100%为重症患者，EP存活组中58.8%的为中重症患者，差异有统计学意义(,P,<,0.05)。EP存活组100%采用升阶梯外科治疗策略。,结论,2,气泡征与IPN的预后无关。早期EP和广泛型EP往往提示预后不良，需积极采取升阶梯外科治疗策略为主的干预。

Abstract

Objective,2,Emphysematous pancreatitis (EP) is a subtype of infectious pancreatic necrosis (IPN). It is characterized by the accumulation of gas inside or around the pancreatic necrotic tissue. This study aims to investigate the relation between classification and prognosis of EP, and to provide guidance for clinical diagnosis and treatment of IPN.,Methods,2,A prospective cohort of 228 cases of IPN from January 2010 to June 2020 in the Department of General Surgery of Xiangya Hospital, Central South University were analyzed. Among them, 120 cases without peritoneal/retroperitoneal surgical intervention before admission were included. The 120 cases of IPN were classified into the EP group and the non-EP group. The general clinical information and results of pathogenic microorganism between the EP and the non-EP group were compared. EP patients were divided into early-EP (within 2 weeks of onset) and late-EP (after 2 weeks of onset) according to the presence timing of air bubble sign, and they were divided into extensive-EP and common-EP according to the distribution characteristics of bubble sign. The clinical characteristics between the survivors and non-survivors of both IPN and EP were compared.,Results,2,Among the 120 IPN patients, 25 (20.8%) were EP patients and 95 (79.2%) were non-EP patients. According to the classifications, 8 were early-EP (32.0%) and 17 were late-EP (68.0%); 15 were common-EP (60.0%) and 10 were extensive-EP (40.0%). There was no significant difference in gender, age, etiology, and mortality between the EP group and the non-EP group (all ,P,>,0.05). The percentage of ,Escherichia coli, infection in the EP group was significantly higher than that in non-EP group (52.0% vs 16.5%,P,<,0.05). Among the 120 IPN patients, 35 died (IPN non-survivors) and 85 patients survived (IPN survivors). The mortality rate of IPN was 29.2%. There was no significant difference in gender, age, and etiology between the IPN non-survivors and the IPN survivors (all ,P,>,0.05). The proportion of severe patients in IPN non-survivors was significantly higher than that in the IPN survivors (97.1% vs 54.1%,P,<,0.05). Among the 25 cases of EP, 8 died (EP non-survivors) and 17 survived (EP survivors). The mortality rate of EP was 32.0%. There was no significant difference in gender, age, etiology, and time from gas detected to surgical intervention between the EP non-survivors and the EP survivors (all ,P,>,0.05). The proportion of early-EP and extensive-EP in the EP non-survivors was significantly higher than that in the EP survivors (both ,P,<,0.05). The mortality was up to 100% in the early- and extensive-EP patients. All of the EP non-survivors were severe patients, while 58.8% of the EP survivors were moderate or severe patients, the difference was statistically significant (,P,<,0.05). All of the EP survivors underwent step-up surgical treatment strategy.,Conclusion,2,Air bubble sign is not associated with the prognosis of IPN. Early- and extensive-EP often indicate worse prognosis. Aggressive surgical intervention based on step-up approach should be considered with priority.

关键词

感染性胰腺坏死气肿型胰腺炎急性胰腺炎早期气肿型胰腺炎广泛型气肿型胰腺炎

Keywords

infected pancreatic necrosisemphysematous pancreatitisacute pancreatitisearly-emphysematous pancreatitisextensive-emphysematous pancreatitis

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