Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 519, Indianapolis, IN, 46202, USA.
Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, IN, USA.
J Gastrointest Surg. 2019 Dec;23(12):2430-2438. doi: 10.1007/s11605-019-04124-0. Epub 2019 Feb 7.
Necrotizing pancreatitis (NP) is a severe systemic inflammatory process. We have observed a high incidence of venous thromboembolism (VTE) in NP patients. However, remarkably few data exist to document the true incidence of VTE-including splanchnic vein thrombosis (SVT), extremity deep venous thrombosis (eDVT), and pulmonary embolism (PE)-in NP. Therefore, we sought to determine the incidence and risk factors for VTE in NP patients.
Retrospective review of all NP patients treated at a single academic center between 2005 and 2015. VTE diagnosis was confirmed by ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and/or ventilation/perfusion (V/Q) scan. Descriptive statistics and univariate analysis were applied where appropriate; p value < 0.05 was considered statistically significant.
Five hundred and forty-five NP patients (median age 53 years; 65% males) were reviewed. VTE was diagnosed in 312 patients (57%). SVT was found in 50%, eDVT in 16%, and PE in 6%. VTE in multiple sites was found in 22% of patients. VTE was diagnosed a median of 37 days following pancreatitis diagnosis. Seventy-nine percent of patients required at least one surgical procedure over the course of their NP. Patients requiring surgery had a DVT incidence of 58%; however, VTE was diagnosed preoperatively in 63%. Male gender, history of previous DVT, infected necrosis, development of organ failure, and development of respiratory failure were identified as risk factors for VTE (p = 0.001-0.04) by univariate analysis.
Venous thromboembolism is extremely common in necrotizing pancreatitis. Regular ultrasound screening may be considered to facilitate early diagnosis in this extremely high-risk population.
坏死性胰腺炎（NP）是一种严重的全身炎症过程。我们观察到 NP 患者中静脉血栓栓塞（VTE）的发生率很高。然而，目前仅有少量数据记录 NP 患者中 VTE（包括脾静脉血栓形成[SVT]、肢体深部静脉血栓形成[eDVT]和肺栓塞[PE]）的确切发生率。因此，我们旨在确定 NP 患者 VTE 的发生率和危险因素。
回顾性分析 2005 年至 2015 年期间在一家学术中心治疗的所有 NP 患者。通过超声（US）、计算机断层扫描（CT）、磁共振成像（MRI）和/或通气/灌注（V/Q）扫描来确认 VTE 的诊断。在适当的情况下应用描述性统计和单变量分析；p 值<0.05 被认为具有统计学意义。
共回顾了 545 例 NP 患者（中位年龄 53 岁；65%为男性）。312 例（57%）患者诊断为 VTE。SVT 发现率为 50%，eDVT 为 16%，PE 为 6%。22%的患者有多个部位的 VTE。VTE 诊断在胰腺炎诊断后中位数 37 天。79%的患者在 NP 病程中至少需要进行一次手术。需要手术的患者 DVT 发生率为 58%；然而，63%的患者术前诊断出 VTE。单变量分析确定男性、既往 DVT 史、感染性坏死、器官衰竭和呼吸衰竭的发展是 VTE 的危险因素（p=0.001-0.04）。
静脉血栓栓塞在坏死性胰腺炎中非常常见。对于这个极高风险人群，可能需要定期进行超声筛查以促进早期诊断。
