Wijffels Niels A T, van Walraven Laurens A, Ophof Peter J A, Hop Wim C J, van der Harst Erwin, Lange Johan F
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Pancreas. 2007 Mar;34(2):215-9. doi: 10.1097/MPA.0b013e31802e01ec.
The purpose of this study is to assess the prognostic significance of late parenchymal pancreas necrosis as observed on serial contrast-enhanced computed tomographic (CT) scan.
Eighty-four patients with acute necrotizing pancreatitis were included. All initial CT scans were examined on complete contrast enhancement of the pancreas parenchyma (viable pancreas) or incomplete enhancement indicating parenchymal necrosis of the pancreas (PN). Secondly, all serial CT scans were evaluated to investigate whether late PN occurred in the group with a viable pancreas on initial CT scan. Characteristics of this group were evaluated.
Thirteen patients showed signs of PN on initial CT scan. Late necrosis occurred in 5 patients. The average hospital stay in this subgroup was 46.7 days; complication rate, 100%; and mortality, 40%. A significant difference in hospital stay (average of 45.1 days vs 24.3 days; P = 0.003), complication rate (72% vs 33%; P = 0.006), and mortality (28% vs 6%; P = 0.019) was found when the group with eventual PN was compared with the group with no signs of PN (on initial and serial CT).
This study shows a significant increase in hospital stay, complication rate, and mortality when eventual PN is shown on CT scan. Patients with late PN especially have a poor prognosis.
本研究旨在评估在系列对比增强计算机断层扫描（CT）上观察到的晚期胰腺实质坏死的预后意义。
纳入84例急性坏死性胰腺炎患者。所有初始CT扫描均检查胰腺实质的完全对比增强（存活胰腺）或提示胰腺实质坏死（PN）的不完全增强。其次，对所有系列CT扫描进行评估，以调查在初始CT扫描显示胰腺存活的患者组中是否发生晚期PN。对该组的特征进行评估。
13例患者在初始CT扫描时显示PN迹象。5例患者发生晚期坏死。该亚组的平均住院时间为46.7天；并发症发生率为100%；死亡率为40%。将最终发生PN的组与无PN迹象（初始和系列CT均无）的组进行比较时，发现住院时间（平均45.1天对24.3天；P = 0.003）、并发症发生率（72%对33%；P = 0.006）和死亡率（28%对6%；P = 0.019）存在显著差异。
本研究表明，当CT扫描显示最终发生PN时，住院时间、并发症发生率和死亡率显著增加。晚期PN患者尤其预后不良。
