感染性胰腺坏死的影像学分型及其治疗效果分析(附126例病例报告)  

Imaging classification and analysis of the diagnosis and treatment of infected pancreatic necrosis:a report of 126 cases

作　　者：鲁天麒 尚莅人 别凡 许艺林 隋宇航 李冠群 陈华[1] 王刚[1] 孔瑞[1] 白雪巍[1] 谭宏涛[1] 王拥卫[1] 孙备[1] Lu Tianqi;Shang Liren;Bie Fan;Xu Yilin;Sui Yuhang;Li Guanqun;Chen Hua;Wang Gang;Kong Rui;Bai Xuewei;Tan Hongtao;Wang Yongwei;Sun Bei(Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University,Key Laboratory of Hepatosplenic Surgery,Ministry of Education,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院胰胆外科、肝脾外科教育部重点实验室,哈尔滨150001

出　　处：《中华外科杂志》2023年第1期33-40,共8页Chinese Journal of Surgery

基　　金：国家自然科学基金(81871974,82070658)。

摘　　要：目的探讨结合临床实践提出的感染性胰腺坏死(IPN)影像学分型中各型IPN的临床特点及不同治疗方式的预后。方法回顾性分析2018年12月至2021年12月哈尔滨医科大学附属第一医院胰胆外科收治的126例IPN患者的临床和影像学资料。其中男性70例(55.6%),女性56例(44.4%),年龄[M(IQR)]44(17)岁(范围:12~87岁)。重症急性胰腺炎(SAP)67例(53.2%),中重症急性胰腺炎59例(46.8%)。所有病例均符合IPN诊断标准。根据CT图像中显示的感染坏死部位不同,将病例分为Ⅰ型(中央型IPN)、Ⅱ型(外周型IPN)、Ⅲ型(混合型IPN)和Ⅳ型(孤立型IPN),分别为21例、23例、74例和8例;另根据治疗策略不同分为创伤递升式(Step-up)治疗策略(Step-up组)和跨越式(Step-jump)治疗策略(Step-jump组),分别为109例和17例。分别采用使用单因素方差分析、t检验、χ^(2)检验或Fisher确切概率法分析各组临床指标及患者预后的差异。结果各型IPN患者在病死率、并发症发生率、并发症等级方面的差异均无统计学意义(P值均>0.05)。与其他三型IPN合计相比,Ⅳ型IPN患者的总住院时间[69(40)d比19(19)d]及总住院费用[32.3(41.9)万元比6.0(7.8)万元]均明显增加(Z=-4.041、-3.972,P值均<0.01)。Ⅳ型IPN患者残余感染的发生率高于其他三型IPN合计(χ^(2)=16.350,P<0.01)。各型IPN患者不同治疗分组之间病死率的差异无统计学意义(P>0.05)。Step-up组总住院时间及总住院费用少于Step-jump组[19(20)d比33(35)d,Z=-2.052,P=0.040;5.9(8.0)万比12.2(10.9)万元,Z=-2.317,P=0.020]。Ⅳ型IPN中Step-up组住院费用高于Step-jump组[33.0(57.8)万元比14.1万元,Z=-2.000,P=0.046]。Step-up组残余感染发生率[17.4%(19/109)]低于Step-jump组(10/17)(χ^(2)=11.980,P=0.001)。结论Ⅳ型IPN患者的感染坏死程度较其他三型更重,患者住院时间更长,住院费用更高。Step-up模式治疗IPN是安全有效的,Step-jump模式可用于治疗位置深在、常规引流方式难以抵�Objective To explore the clinical characteristics of various types of infected pancreatic necrosis(IPN)and the prognosis of different treatment methods in the imaging classification of IPN proposed.Methods The clinical data of 126 patients with IPN admitted to the Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University from December 2018 to December 2021 were analyzed retrospectively.There were 70 males(55.6%)and 56 females(44.4%),with age(M(IQR))of 44(17)years(range:12 to 87 years).There were 67 cases(53.2%)of severe acute pancreatitis and 59 cases(46.8%)of moderately severe acute pancreatitis.All cases were based on the diagnostic criteria of IPN.All cases were divided into TypeⅠ(central IPN)(n=21),TypeⅡ(peripheral IPN)(n=23),TypeⅢ(mixed IPN)(n=74)and TypeⅣ(isolated IPN)(n=8)according to the different sites of infection and necrosis on CT.According to different treatment strategies,they were divided into Step-up group(n=109)and Step-jump group(n=17).The clinical indicators and prognosis of each group were observed and analyzed by ANOVA,t-test,χ^(2) test or Fisher exact test,respectively.Results There was no significant difference in mortality,complication rate and complication grade in each type of IPN(all P>0.05).Compared with other types of patients,the length of stay(69(40)days vs.19(19)days)and hospitalization expenses(323000(419000)yuan vs.60000(78000)yuan)were significantly increased in TypeⅣIPN(Z=-4.041,-3.972;both P<0.01).The incidence of postoperative residual infection of TypeⅣIPN was significantly higher than that of other types(χ^(2)=16.350,P<0.01).There was no significant difference in the mortality of patients with different types of IPN between different treatment groups.The length of stay and hospitalization expenses of patients in the Step-up group were significantly less than those in the Step-jump group(19(20)days vs.33(35)days,Z=-2.052,P=0.040;59000(80000)yuan vs.122000(109000)yuan,Z=-2.317,P=0.020).Among the patients in TypeⅣIP

关 键 词：胰腺炎 外科手术 微创性 感染性胰腺坏死 分型 

分 类 号：R576[医药卫生—消化系统]