中国实用外科杂志

中国实用外科杂志

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经皮内镜下清创感染性胰腺坏死组织失败危险因素分析

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  1. 1南方医科大学第一临床医学院附属金陵医院 重症胰腺炎治疗中心  210002；2南京大学附属金陵医院 重症胰腺炎治疗中心  210002；3东南大学附属金陵医院 重症胰腺炎治疗中心  210002
  • 出版日期:2021-02-01 发布日期:2021-02-05

  • Online:2021-02-01 Published:2021-02-05

摘要： 目的    探讨影响感染性胰腺坏死（IPN）病人经皮内镜下清创（PEN）治疗失败的风险因素。 方法    回顾性分析2017年1月至2017年12月中国人民解放军东部战区总医院重症急性胰腺炎中心诊治的56例IPN病人临床资料，根据是否接受开放手术以及死亡的结局，分为PEN成功组（42例）与PEN失败组（14例）。观察比较两组病人入院临床特征、清创操作步骤及预后，并对影响PEN失败的相关因素进行单因素分析和多因素分析。结果    PEN总体成功率为75.0%。与PEN成功组相比，PEN失败组入院时急性生理及慢性健康状况Ⅱ（APACHE Ⅱ）评分、序贯器官功能衰竭（SOFA）评分，持续器官功能衰竭比例、使用机械通气和血管活性药物使用率的病人比例均更高（P均<0.05）；但PEN失败组的IPN诊断距发病病程、首次PEN距发病病程均更短（P<0.05），增强CT影像学特征中边界清晰和气泡征的病人比例更低（P<0.05）。单因素分析结果显示APACHE Ⅱ评分、SOFA评分、机械通气、血管活性药物、IPN诊断距发病病程、首次PEN距发病病程、首次PEN距发病病程，边界清晰和气泡征的增强CT影像学征象与PEN失败相关（P<0.05）。多因素分析结果显示SOFA评分高是PEN失败的独立影响因素（P<0.05）。 结论    APACHE Ⅱ评分、SOFA评分、机械通气、血管活性药物、IPN诊断距发病病程、首次PEN距发病病程、增强CT影像学表现为即边界清晰和气泡征是PEN失败的危险因素，高SOFA评分是PEN失败独立危险因素。

关键词: 重症急性胰腺炎, 感染性胰腺坏死组织, 经皮内镜下清创

Abstract: Analysis of risk factors for failure of percutaneous endoscopic necrosectomy in patients with infected pancreatic necrosis        XIAO Xiao-jia*, LI Gang, QU Cheng, et al.*Severe Pancreatitis Treatment Center, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing 210002, China
Corresponding author：LI Wei-qin,E-mail：liweiqindr@vip.163.com
Abstract    Objective    To explore the risk factors impacting clinical outcome of patients with infected pancreatic necrosis（IPN）undergoing percutaneous endoscopic necrosectomy（PEN）. Methods    A retrospective review of 56 IPN patients who underwent at least one PEN from January 2017 to December 2017 in the center of severe acute pancreatitis, General Hospital of Eastern Theater Command was performed. According to the need for open necrosectomy and hospitalization mortality, the IPN patients were classified into two groups: the PEN success group (n=42) and the PEN failure group (n=14). The demographic characteristics at admission, endoscopic procedures and clinical outcomes of enrolled patients were recorded and analyzed. Further univariate and multivariate logistic regression analysis were taken to evaluate the risk factors for PEN failure. Results    The overall success rate of the patients was 75.0%. Compared with the PEN success group, the patients in the PEN failure group had a higher APACHE II score, SOFA score and more percents of persistent organ failure, application of mechanical ventilation and inotropic support at admission with significance (P<0.05) . However, the duration from disease onset to IPN and to the first endoscopic treatment were significantly longer in the PEN success group than the PEN failure group (P<0.05). Clear boundaries and bubble sign in the contrast-enhanced computed tomography (CECT) were found in more percents of the patients of the PEN success group than the PEN failure group (P<0.05). Univariate logistic regression analysis indicated that significant associations between PEN failure and APACHE Ⅱscore, SOFA score, mechanical ventilation, inotropic support, duration from AP onset to IPN and first PEN, and the clear boundaries and bubble sign on CECT imaging (P<0.05). Multivariate logistic regression analysis showed that high SOFA score was independently associated with PEN failure (P<0.05). Conclusion  APACHE Ⅱ score, SOFA score, mechanical ventilation, inotropic support, the duration from disease to IPN and to the first PEN and the clear boundaries and bubble sign on CECT imagine are found the risk factors. High SOFA score is found the independent risk factor.

Key words: severe acute pancreatitis, infected pancreatic necrosis, percutaneous endoscopic necrosectomy