Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Gut. 2013 Oct;62(10):1475-80. doi: 10.1136/gutjnl-2012-302870. Epub 2012 Jul 7.
In the revised Atlanta classification of acute pancreatitis, the term necrotising pancreatitis also refers to patients with only extrapancreatic fat necrosis without pancreatic parenchymal necrosis (EXPN), as determined on contrast-enhanced CT (CECT). Patients with EXPN are thought to have a better clinical outcome, although robust data are lacking.
A post hoc analysis was performed of a prospective multicentre database including 639 patients with necrotising pancreatitis on contrast-enhanced CT. All CECT scans were reviewed by a single radiologist blinded to the clinical outcome. Patients with EXPN were compared with patients with pancreatic parenchymal necrosis (with or without extrapancreatic necrosis). Outcomes were persistent organ failure, need for intervention and mortality. A predefined subgroup analysis was performed on patients who developed infected necrosis.
315 patients with EXPN were compared with 324 patients with pancreatic parenchymal necrosis. Patients with EXPN less often suffered from complications: persistent organ failure (21% vs 45%, p<0.001), persistent multiple organ failure (15% vs 36%, p<0.001), infected necrosis (16% vs 47%, p<0.001), intervention (18% vs 57%, p<0.001) and mortality (9% vs 20%, p<0.001). When infection of extrapancreatic necrosis developed, outcomes between groups were equal (mortality with infected necrosis: EXPN 28% vs pancreatic necrosis 18%, p=0.16).
EXPN causes fewer complications than pancreatic parenchymal necrosis. It should therefore be considered a separate entity in acute pancreatitis. Outcome in cases of infected necrosis is similar.
在修订后的亚特兰大急性胰腺炎分类中，坏死性胰腺炎一词也指仅在外周胰腺脂肪坏死而无胰腺实质坏死（EXPN）的患者，这是在增强 CT（CECT）上确定的。尽管缺乏强有力的数据，但认为有 EXPN 的患者临床结局更好。
对包括 639 例 CECT 证实的坏死性胰腺炎患者的前瞻性多中心数据库进行了事后分析。所有 CECT 扫描均由一位对临床结果不知情的单一放射科医生进行盲法评估。将有 EXPN 的患者与有胰腺实质坏死（有或无胰周坏死）的患者进行比较。结果为持续性器官衰竭、需要干预和死亡率。对发生感染性坏死的患者进行了预设的亚组分析。
将 315 例有 EXPN 的患者与 324 例有胰腺实质坏死的患者进行了比较。有 EXPN 的患者并发症发生率较低：持续性器官衰竭（21%比 45%，p<0.001）、持续性多器官衰竭（15%比 36%，p<0.001）、感染性坏死（16%比 47%，p<0.001）、干预（18%比 57%，p<0.001）和死亡率（9%比 20%，p<0.001）。当胰周坏死发生感染时，两组之间的结果相同（感染性坏死的死亡率：EXPN 为 28%，胰腺坏死为 18%，p=0.16）。
EXPN 比胰腺实质坏死引起的并发症更少。因此，在急性胰腺炎中应将其视为一个独立的实体。感染性坏死的结局相似。
