Rana Surinder S, Chhabra Puneet, Sharma Ravi, Sharma Vishal, Gupta Rajesh, Bhasin Deepak K
Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin).
Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin); Current affiliation: Fortis Hospital, Mohali, India.
Ann Gastroenterol. 2017;30(2):232-236. doi: 10.20524/aog.2016.0106. Epub 2016 Nov 14.
Extrapancreatic necrosis is diagnosed on computed tomography (CT) as extrapancreatic changes that are more than fat stranding; both fluid collections and necrosis would have a similar appearance. The aim of this study was to determine the prognostic significance of differentiating peripancreatic necrosis from fluid collection on endoscopic ultrasound (EUS) in patients with presumed isolated extrapancreatic necrosis.
We carried out a retrospective analysis of prospectively collected data from 36 patients (25 males; age range 19-65 years) with acute pancreatitis (AP) and isolated extrapancreatic necrosis. On EUS, peripancreatic anechoic areas were labeled as peripancreatic fluid collections and peripancreatic heterogeneously echotextured areas as peripancreatic necrosis.
The etiology of AP was alcohol in 16 (44.4%) patients, gallstone disease in 13 (36.1%), and other in 7 (19.4%). On EUS, 25 (69.4%) patients had peripancreatic necrosis and 11 (30.6%) patients had peripancreatic fluid collections. Compared with patients who had peripancreatic fluid collections, patients with peripancreatic necrosis had a significantly higher frequency of pleural effusion (88% vs. 55%; P=0.04), organ failure (OF) (68% vs. 27%; P=0.03), and persistent OF (48% vs. 9%; P=0.03). The patients with peripancreatic necrosis also had a higher frequency of ascites (20% vs. 9%), need for intervention (20% vs. nil), surgery (8% vs. nil) and mortality (8% vs. nil), but these differences were not statistically significant.
Isolated extrapancreatic necrosis on contrast-enhanced CT comprises a heterogeneous group, with patients who show peripancreatic fluid collections on EUS having a less severe disease course compared to patients with peripancreatic necrosis.
在计算机断层扫描（CT）上，胰腺外坏死被诊断为超过脂肪条索的胰腺外改变；液体积聚和坏死在CT上可能有相似表现。本研究的目的是确定在内镜超声（EUS）下区分疑似孤立性胰腺外坏死患者胰周坏死和液体积聚的预后意义。
我们对前瞻性收集的36例急性胰腺炎（AP）并伴有孤立性胰腺外坏死患者（25例男性；年龄范围19 - 65岁）的数据进行了回顾性分析。在EUS检查中，胰周无回声区被标记为胰周液体积聚，胰周回声不均匀区被标记为胰周坏死。
AP的病因中，16例（44.4%）为酒精性，13例（36.1%）为胆结石病，7例（19.4%）为其他原因。在EUS检查中，25例（69.4%）患者有胰周坏死，11例（30.6%）患者有胰周液体积聚。与有胰周液体积聚的患者相比，有胰周坏死的患者胸腔积液发生率显著更高（88%对55%；P = 0.04）、器官衰竭（OF）发生率显著更高（68%对27%；P = 0.03）以及持续性OF发生率显著更高（48%对9%；P = 0.03）。有胰周坏死的患者腹水发生率也更高（20%对9%）、干预需求更高（20%对无）、手术率更高（8%对无）以及死亡率更高（8%对无），但这些差异无统计学意义。
对比增强CT上的孤立性胰腺外坏死包括一组异质性患者，与有胰周坏死的患者相比，EUS显示有胰周液体积聚的患者病程较轻。
