急性胰腺炎合并坏死感染经皮穿刺置管引流效果的影响因素  

Influence factors of the effect of percutaneous catheter drainage on acute pancreatitis complicated with necrotic infection

作　　者：王育斌[1] 张长青[1] 张葵玲[1] 周阿佩 WANG Yubin;ZHANG Changqing;ZHANG Kuiling;ZHOU Apei(Department of Gastroenterology, Quanzhou First Hospital, Quanzhou Fujian 362000, Chin)

机构地区：[1]福建省泉州市第一医院消化内科,福建泉州362000

出　　处：《临床与病理杂志》2018年第5期992-997,共6页Journal of Clinical and Pathological Research

基　　金：福建省泉州市卫生计生科研资助项目(2009Z79);泉州市第一医院青年科研课题(35)~~

摘　　要：目的:探讨急性胰腺炎(acute pancreatitis,AP)合并坏死感染经皮穿刺置管引流术(percutaneous catheter drainage,PCD)治疗效果的影响因素。方法:回顾性分析2014年10月至2017年8月我院收治74例经PCD治疗的AP合并坏死感染患者的临床和CT影像学资料。通过单因素和多因素logistic回归分析能够有效预测PCD治疗效果的临床和影像学指标。结果:本组AP合并坏死感染接受PCD治疗成功率为58.1%(43/74),PCD失败转为手术清创者31例(41.9%)。单因素分析发现:CT影像学指标中胰腺坏死范围(P<0.001)、感染灶范围(P=0.038)、数目(P=0.010)、成份(P=0.001)、包裹程度(P=0.029),临床指标中是否并发持续性器官衰竭(P=0.013),与PCD治疗效果存在显著关联性;而人口学特征中年龄、性别、病因学诊断以及临床指标中AP严重程度床边指数(bedside index for severity in AP,BISAP)评分、白细胞计数、CRP、是否并发器官衰竭和器官衰竭数目以及一过性器官衰竭与PCD治疗效果未存在显著关联性(P>0.05)。多因素Cox回归分析发现,只有胰腺坏死范围>50%(OR=1.75,95%CI 1.39~3.76,P=0.013)、多发感染灶(OR=2.04,95%CI1.83~5.92,P=0.001)、感染灶成分不均质(OR=2.76,95%CI 1.47~6.58,P<0.001)和持续性器官衰竭(OR=1.27,95%CI 1.20~2.97,P=0.035)是AP合并坏死感染接受PCD治疗失败的独立预测因子。结论:PCD治疗AP合并坏死感染的成功率较高,CT影像学评估尤其是感染灶成分、数目和胰腺坏死范围对预测PCD治疗效果具有重要价值。Objective： To investigate the factors of influencing the effect of percutaneous catheter drainage（PCD） on the treatment of acute pancreatitis（AP） complicated with necrotic infection. Methods： The clinical and CT imaging data of 74 patients with AP complicated with necrotic infection treated by PCD in our hospital from October2014 to August 2017 were analyzed retrospectively. Single factor and multiple factor Logistic regression analysis were performed to determine the clinical and radiological prediction index of PCD treatment outcome.Results： Among these patients, the success rate of PCD was 58.1%（43/74）, and 31 cases（41.9%） were converted to surgical necrosectomy after previous PCD. Single factor analysis showed that the imaging index of percentage of pancreatic necrosis（P0.001）, size（P=0.038）, number（P=0.010）, contents（P=0.001） and encapsulation of the collection（P=0.029）, and the clinical indicators of persistent organ failure（P=0.013） were significantly associated with the outcome of PCD. However, the demographic characteristics of age, gender, etiology, bedside index for severity in AP（BISAP）, white blood cell count, C reaction protein, organ failure（with or without, solitary or multiple, transient or not） had no significant association with the outcome of PCD（P〈0.05）. Multivariate Cox regression analysis showed that only the percentage of pancreatic necrosis 50%（OR=1.75, 95%CI 1.39–3.76,P=0.013）, multiple collection（OR=2.04, 95%CI 1.83–5.92, P=0.001）, heterogeneous collection（OR=2.76,95%CI 1.47–6.58, P〈0.001） and persistent organ failure（OR=1.27, 95%CI 1.20–2.97, P=0.035） were the independent predictors of PCD converted to surgical necrosectomy for treating infected necrotizing pancreatitis.Conclusion： PCD has a high success rate for the necrosis infection of AP. CT imaging evaluation, especially the contents and number of collection, and the percentage of pancreatic necrosis, has a important value in predicting the out

关 键 词：急性胰腺炎 坏死感染 经皮穿刺置管引流术 

分 类 号：R576[医药卫生—消化系统]