Rana Surinder S, Sharma Vishal, Sharma Ravi K, Chhabra Puneet, Gupta Rajesh, Bhasin Deepak K
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
J Gastroenterol Hepatol. 2015 Apr;30(4):794-8. doi: 10.1111/jgh.12793.
Extrapancreatic necrosis (EPN) alone represents a subgroup of pancreatitis with better outcome than patients with pancreatic parenchymal necrosis (PN). However, data on clinical significance of EPN is limited, and significance of the extent of EPN is not known.
Two hundred thirteen patients (136 [63.8%] males; mean age: 39.8 ± 13.2 years) with acute pancreatitis were prospectively enrolled and followed up till recovery or death. Contrast-enhanced computed tomography of each patient was retrospectively evaluated for presence of PN and EPN, pleural effusion and ascites. EPN was termed extensive if it extended to paracolic gutters or pelvis.
Twenty-one (9.9%) patients had interstitial pancreatitis, seven (3.3%) patients had PN alone, 48 (22.5%) patients had EPN alone, and 137 (64.3%) patients had combined PN and EPN. Patients with EPN alone had significantly higher frequency of organ failure than patients with interstitial pancreatitis. Compared with patients with EPN alone, the patients with combined necrosis had significantly higher frequency of pleural effusion (88.2% vs. 75%), ascites (41% vs. 20.8%), and need for intervention (32.6% vs. 14.6%). Patients with extensive EPN (n = 57) had significantly higher frequency of pleural effusion, ascites, and multi-organ failure than those with limited EPN.
EPN alone should be considered as a separate category of acute pancreatitis as it has less severe course than PN but has more severe course than interstitial pancreatitis. Patients with extensive EPN in spite of having increased frequency of ascites, pleural effusion, and multi-organ failure had similar outcome as compared to patients with limited EPN.
单纯胰腺外坏死（EPN）是胰腺炎的一个亚组，其预后优于胰腺实质坏死（PN）患者。然而，关于EPN临床意义的数据有限，且EPN范围的意义尚不清楚。
前瞻性纳入213例急性胰腺炎患者（136例[63.8%]为男性；平均年龄：39.8±13.2岁），随访至康复或死亡。回顾性评估每位患者的增强CT，以确定是否存在PN和EPN、胸腔积液和腹水。如果EPN延伸至结肠旁沟或盆腔，则称为广泛EPN。
21例（9.9%）患者为间质性胰腺炎，7例（3.3%）患者仅患有PN，48例（22.5%）患者仅患有EPN，137例（64.3%）患者同时患有PN和EPN。仅患有EPN的患者器官衰竭的发生率显著高于间质性胰腺炎患者。与仅患有EPN的患者相比，合并坏死的患者胸腔积液（88.2%对75%）、腹水（41%对20.8%）和需要干预的发生率显著更高（32.6%对14.6%）。广泛EPN患者（n = 57）胸腔积液、腹水和多器官衰竭的发生率显著高于有限EPN患者。
单纯EPN应被视为急性胰腺炎的一个单独类别，因为其病程比PN轻，但比间质性胰腺炎重。尽管广泛EPN患者腹水、胸腔积液和多器官衰竭的发生率增加，但其预后与有限EPN患者相似。
