Ocampo Carlos, Zandalazini Hugo, Kohan Gustavo, Silva Walter, Szelagowsky Carlos, Oría Alejandro
Departments of Surgery, Cosme Argerich Hospital, Buenos Aires, Argentina.
Pancreas. 2009 Mar;38(2):137-42. doi: 10.1097/MPA.0b013e31818de20a.
This prospective study aimed at evaluating dynamic computed tomography (CT) as a prognostic indicator of local complications in patients with pancreatic necrosis.
We analyze the relationship between the anatomic pattern of pancreatic necrosis at dynamic CT (pancreatic necrosis, peripancreatic necrosis, and transparenchymal necrosis) and the development of local complications (infected pancreatic necrosis and pseudocyst).
One hundred thirty-eight patients were included in the study. Nine patients were excluded, and 86 required surgery. Average time from the onset of symptoms to dynamic CT was 8.3 days. Multivariate analysis identified the following prognostic factors for local complications: (1) extent of pancreatic necrosis (odds ratio [OR], 7.32; 95% confidence interval [CI], 1.32-23.76; P = 0.015) and presence of peripancreatic necrosis (OR, 37.32; 95% CI, 3.77-369.38; P = 0.002) were useful to predict the development of infected pancreatic necrosis; and (2) transparenchymal necrosis with upstream viable (enhancing) pancreas (OR, 36.22; 95% CI, 3.18-412.36; P = 0.004) and no peripancreatic necrosis (OR, 0.016; 95% CI, 0.004-0.62; P < 0.001) were associated with pseudocyst development.
Dynamic CT prognostic factors useful to predict local complications in patients with pancreatic necrosis were the extent of pancreatic necrosis, presence of peripancreatic necrosis, and the finding of transparenchymal necrosis with upstream viable (enhancing) pancreas.
本前瞻性研究旨在评估动态计算机断层扫描（CT）作为胰腺坏死患者局部并发症的预后指标。
我们分析了动态CT上胰腺坏死的解剖模式（胰腺坏死、胰周坏死和穿实质坏死）与局部并发症（感染性胰腺坏死和假性囊肿）发生之间的关系。
138例患者纳入研究。9例被排除，86例需要手术。从症状出现到动态CT的平均时间为8.3天。多因素分析确定了以下局部并发症的预后因素：（1）胰腺坏死范围（比值比[OR]，7.32；95%置信区间[CI]，1.32 - 23.76；P = 0.015）和胰周坏死的存在（OR，37.32；95% CI，3.77 - 369.38；P = 0.002）有助于预测感染性胰腺坏死的发生；（2）上游有存活（强化）胰腺的穿实质坏死（OR，36.22；95% CI，3.18 - 412.36；P = 0.004）和无胰周坏死（OR，0.016；95% CI，0.004 - 0.62；P < 0.001）与假性囊肿的发生相关。
有助于预测胰腺坏死患者局部并发症的动态CT预后因素是胰腺坏死范围、胰周坏死的存在以及上游有存活（强化）胰腺的穿实质坏死的发现。
