急性胰腺炎有创治疗相关肠瘘的临床分析  

Clinical analysis of intestinal fistula associated with invasive intervention for acute pancreatitis

作　　者：闫夏晓 周婧雅[2,3] 曹剑[2,4] 徐强[2,5] 韩显林[2,5] 张晟瑜[1,2] 吴东[1,2] Yan Xiaxiao;Zhou Jingya;Cao Jian;Xu Qiang;Han Xianlin;Zhang Shengyu;Wu Dong(Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Beijing 100730,China;Department of Medical Records,Peking Union Medical College Hospital,Bejing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Bejing 100730,China;Department of General Surgery,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院消化内科,北京100730 [2]北京协和医院疑难重症及罕见病国家重点实验室,北京100730 [3]北京协和医院病案科,北京100730 [4]北京协和医院放射科,北京100730 [5]北京协和医院基本外科,北京100730

出　　处：《中华胰腺病杂志》2024年第1期17-22,共6页Chinese Journal of Pancreatology

基　　金：国家自然科学基金(32170788);中央高水平医院临研专项(2022-PUMCH-B-023);国家临床重点专科建设项目(ZK108000);北京市自然科学基金(7232123)。

摘　　要：目的探讨AP患者有创治疗相关肠瘘的临床特征。方法回顾性分析2003年1月至2022年12月间北京协和医院177例行有创干预的MSAP和SAP患者的临床资料。根据干预术中或术后有无相关性肠瘘发生,将患者分为肠瘘组和无肠瘘组。记录患者的年龄、性别、病因、SIRS、器官功能衰竭、修订版亚特兰大分级、BISAP评分、Balthazar CT分级、局部并发症胰外受累情况、局部并发症继发感染情况、干预指征、干预时机、干预策略、住院时长、重症监护时长和结局。比较两组患者临床特征的差异。结果共21例患者(11.9%)于有创干预术中或术后发现肠瘘,其中8例于经皮穿刺术中或术后,13例于外科手术术中或术后。51例行内镜下引流或内镜下清创,无内镜操作后肠瘘发生。与无肠瘘组比较,肠瘘组患者的中位年龄较小(36岁比45岁,P=0.014),发生SIRS(95.2%比59.6%,P=0.001)、局部并发症胰外受累(100.0%比67.3%,P=0.002)和继发感染(71.4%比36.5%,P=0.002)的比例更高,中位住院时间(71 d比40 d,P=0.002)和重症监护时间(8 d比0,P=0.016)更长。肠瘘组患者均存在影像学或术中所见的胰周及腹腔、腹膜后受累。肠瘘发生部位主要为结肠(13例,61.9%)和十二指肠(6例,28.6%)。肠瘘确诊主要通过经引流管造影(11例)或消化道造影(5例)。13例结肠瘘患者中,9例首选非手术治疗,4例首选瘘口修补或近端造口术;8例非结肠瘘患者中,7例首选非手术治疗,仅1例在术中发现肠瘘时即进行修补。结论肠瘘是重症AP的并发症之一,与有创干预之间存在密切关联。改进有创干预策略,可能有助于预防肠瘘形成;对肠瘘进行及时有效的处理,有利于避免病情复杂化并可缩短住院时间。Objective To analyze the clinical characteristics of invasive intervention-related intestinal fistula in patients with acute pancreatitis(AP).Methods We retrospectively analyzed the clinical data of 177 moderately severe acute pancreatitis(MSAP)or severe acute pancreatitis(SAP)patients who received invasive intervention in Peking Union Medical College Hospital from January 2003 to December 2022.Patients were divided into fistula group and non-fistula group based on the presence or absence of fistula after or during receiving invasive interventions.The age,gender,etiology,systemic inflammatory response syndrome(SIRS),impairment of organ function,revised Atlanta classification,bedside index of severity of acute pancreatitis(BISAP),Balthazar CT classification,extra-pancreatic involvement and secondary infection of local complications,indications,timing and modalities of invasive interventions,length of hospitalization,length of intensive care and outcomes were recorded.The differences on clinical characteristics were compared between the two groups.Results Intestinal fistulae were found in 21(11.9%)cases during or after invasive intervention,including 8 during or after percutaneous drainage and 13 during or after surgeries.51 cases received endoscopic drainage or debridement and no intestinal fistula occurred after endoscopic management.Compared to patients without fistula,the median age was younger in the fistula group(36 vs 45 years,P=0.014),and the occurrence of SIRS(95.2%vs 59.6%,P=0.001),extra-pancreatic invasion(100.0%vs 67.3%,P=0.002),and secondary infection(71.4%vs 36.5%,P=0.002)were higher.Patients with fistula had a longer median length of hospitalization(71 vs 40 days,P=0.016)and intensive care(8 vs 0 days,P=0.002).All patients in the fistula group had peri-pancreatic,abdominal and retroperitoneal involvement seen on imaging or intraoperatively.The intestinal fistulae mainly occurred in the colon(n=13,61.9%)and the duodenum(n=6,28.6%).The confirmed diagnosis of fistulae was based on transfistula imaging(n

关 键 词：急性胰腺炎 肠瘘 有创干预 

分 类 号：R576[医药卫生—消化系统]