创伤递升式策略和跨越式策略治疗感染性胰腺坏死的疗效分析  

Analysis of therapeutic effects of step-up versus step-jump strategies in treatment of infected pancreatic necrosis

作　　者：白睿 鲁天麒 尚莅人 别凡 许艺林 陈华[1] 王刚[1] 孔瑞[1] 谭宏涛[1] 王拥卫[1] 孙备[1] Bai Rui;Lu Tianqi;Shang Liren;Bie Fan;Xu Yilin;Chen Hua;Wang Gang;Kong Rui;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：《中华肝胆外科杂志》2023年第4期258-262,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(82070658、82270665);黑龙江省自然科学基金(TD2021H001)。

摘　　要：目的探讨创伤递升式策略和跨越式策略治疗感染性胰腺坏死(IPN)的安全性和疗效。方法回顾性分析2018年12月至2022年11月在哈尔滨医科大学附属第一医院胰胆外科接受创伤递升式策略或跨越式策略治疗的IPN患者的临床资料。按照最邻近匹配法1∶1比例进行倾向性评分匹配分组,矫正基线资料后(卡钳值为0.01),共纳入62例IPN患者,其中男性41例,女性21例,年龄(41.1±13.1)岁。采用创伤递升式治疗策略的患者分为创伤递升式组,采用跨越式策略治疗的患者分为跨越式组,每组31例。比较两组患者的住院费用和治疗效果等临床资料。结果 62例IPN患者中,43例接受外科干预治疗,19例通过对症消炎治疗或经皮穿刺置管引流术得以治愈。跨越式组患者的总住院费用高于创伤递升式组[12.2(7.3,17.9)万元比8.8(4.6,14.4)万元],差异具有统计学意义(P=0.034)。跨越式组IPN患者总体治愈率达到93.5%(29/31),共死亡2例,均为Ⅲ型IPN。创伤递升组IPN患者全部治愈,总体治愈率达到100%(31/31),无死亡患者。两组患者在死亡、术后并发症、残余感染、清创次数≧2次、血液或引流液细菌培养阳性等方面差异均无统计学意义(均P>0.05)。共19.4%(12/62)的患者术后出现并发症,其中腹腔出血4例,新发器官功能障碍3例,消化道出血2例,消化道瘘2例,双下肢静脉血栓1例。结论与创伤递升式治疗策略相比,跨越式治疗策略对于特定的IPN患者同样安全有效。Objective To compare the safety and efficacy of the"step-up approach"versus the"step-jump approach"in treatment of infected pancreatic necrosis(IPN).Method The clinical data of IPN patients who underwent step-up strategy or step-jump strategy treatment at the Department of Pancreatic and Biliary Surgery of the First Affiliated Hospital of Harbin Medical University from December 2018 to November 2022 were analyzed retrospectively.Propensity score matching(PSM)was done based on the nearest neighbor matching method(1:1 ratio).After matching the baseline data(the caliper value was 0.01),a total of 62 patients with IPN were included,including 41 males and 21 females,aged(41.1±13.1)years old.Patients who were treated with the step-up strategy were included in the step-up group,while patients who were treated with the step-jump strategy were included in the step-jump group.There were 31 patients in each group after PSM,and the treatment effect of the two groups were compared.Results Of the 62 patients with IPN,43 received surgical intervention,and 19 were managed successfully using symptomatic anti-inflammatory treatment or percutaneous catheter drainage.The total hospitalization cost of patients in the step-jump group was significantly higher than that in the step-up group[122000(73000,179000)yuan vs.88000(46000,144000)yuan,P=0.034].The overall cure rate of IPN patients in the step-jump group was 93.5%(29/31).The 2 patients who died had typeⅢIPN.In the IPN patients in the step-up group were all cured,and the overall cure rate was 100%(31/31),with no death.There were no statistical differences between the two groups in the rates of death,postoperative complications,residual infection,debridement≥2 times,and positive bacterial culture in blood or drainage fluid(all P>0.05).A total of 19.4%(12/62)patients had postoperative complications,including 4 patients with abdominal bleeding,3 patients with new organ dysfunction,2 patients with gastrointestinal bleeding,2 patients with gastrointestinal fistula,and 1 patient wit

关 键 词：胰腺炎 感染性胰腺坏死 外科治疗 

分 类 号：R576[医药卫生—消化系统]