中国实用外科杂志

中国实用外科杂志

• 论蓍 • 上一篇    下一篇

胰腺坏死组织感染并发十二指肠瘘诊治及预后研究

张敬柱，杨    洁，李    刚，张    和，柯    路，周    晶，叶    博，刘玉秀，童智慧，李维勤   

  1. 南京大学医学院附属金陵医院  东部战区总医院重症胰腺炎治疗中心，江苏南京210002
  • 出版日期:2021-03-01 发布日期:2021-03-18

  • Online:2021-03-01 Published:2021-03-18

摘要： 目的    研究胰腺坏死组织感染（IPN）病人并发十二指肠瘘的诊治以及预后情况。方法    回顾性分析2018年1月至2019年12月东部战区总医院重症胰腺炎治疗中心510例IPN病人资料，其中并发十二指肠瘘病人46例，按照倾向性评分（卡钳值0.2）进行1∶1匹配，将其与非十二指肠瘘病人进行1∶1匹配分析。结果    IPN并发十二指肠瘘的发生率为9.0%（46/510）。76.1%十二指肠瘘通过窦道造影确诊；十二指肠瘘主要发生在十二指降部或升部，占91.2%；鼻肠管可以解决绝大部分（91.4%）十二指肠瘘病人的营养通路问题。非手术干预治愈率达97.82%。倾向性评分分析结果表明与IPN未并发十二指肠瘘病人相比，并发十二指肠瘘病人的住院时间更长［（40.93±34.02）d vs.（29.35±19.40） d，P=0.048］，腹腔出血发生比例较高［20例（43.5%） vs. 11例（23.9%），P=0.047］；但在全身并发症急性呼吸窘迫综合征（ARDS）［29例（61.7%）vs. 24例（52.1%），P=0.291］、AKI［22例（46.8%）vs. 23例（50.0%），P=0.835］发生率和死亡率［7例（15.2%）vs. 6例（13.0%），P=0.765］方面差异均无统计学意义。结论    窦道造影是IPN并发十二指肠瘘的主要诊断方式；非手术治疗是十二指肠瘘的主要治愈方式；IPN并发十二指肠瘘病人的住院时间更长，出血发生率更高。

关键词: 胰腺坏死组织感染, 十二指肠瘘, 肠内营养

Abstract: Management of duodenal ?stulas in infected pancreatic necrosis patients: A propensity score matching                        ZHANG Jing-zhu, YANG Jie, LI Gang, et al.  Severe Acute Pancreatitis Treatment Center, General Hospital of Eastern Theater Command；Jinling Clinical Medical College of Nanjing Medical University, Nanjing 210002, China
Corresponding author：TONG Zhi-hui, E-mail:njzyantol@hotmail.com
Abstract    Objective    To investigate the diagnosis，treatment and clinical prognosis of duodenal fistula in severe acute pancreatitis patients（SAP）with infected pancreatic necrosis（IPN）. Methods    The clinical records of 510 IPN patients admitted between January 2018 and December 2019 at Severe Acute Pancreatitis Treatment Center, General Hospital of Eastern Theater Command were analyzed retrospectively. Among them, the records of 46 patients who had got duodenal fistula with infected IPN were performed for propensity score matching（1∶1）. Results    Of the patients, duodenal ?stula was present in 46（9.0%）. The main diagnostic process of duodenal ?stula in patients with IPN were ?stulography by drainage tube which account for 76.1%. Most duodenal fistulas（91.2%）occurred in the descending or ascending part of the duodenum，and most duodenal fistulas（91.4%）could be solved by naso-intestinal tube for nutrition. Compared with severe pancreatitis IPN without duodenal fistula，duodenal fistula had a longer hospital stay ［（40.93±34.02）vs.（29.35±19.4），P=0.048］，and more abdominal hemorrhage ［20（43.5%）vs. 11（23.9%），P=0.047］. There was no significant difference in ARDS［29（61.7%）vs. 24（52.1%），P=0.291］，AKI［22（46.8%）vs. 23（50.0%），P=0.835］，and mortality ［7（15.2%）vs. 6（13.0%），P=0.765］ . Conclusion    The main diagnostic process of duodenal ?stula in IPN patients is ?stulography. The leading treatment is to adjust the position of the naso-intestinal tube for enteral nutrition and drainage strategy. Compared with none fistula with IPN，there is no statistical difference in systemic complications and mortality except for higher abdominal hemorrhage rate and longer hospital days

Key words: infected pancreatitis necrosis, duodenal ?stula, enteral nutrition