Mirnezami Alex, Knight Ben, Moran Brendan, Noble Fergus, Branagan Graham, Primrose John, Pearson Katherine, West Malcolm, Curtis Nathan, Pucher Phil, Cuttress Ramsey, Pugh Sian, Underwood Tim
Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Ann R Coll Surg Engl. 2019 Sep;101(7):487-494. doi: 10.1308/rcsann.2019.0055. Epub 2019 Jul 30.
Acute pancreatitis is a common surgical emergency. Identifying variations in presentation, incidence and management may assist standardisation and optimisation of care. The objective of the study was to document the current incidence management and outcomes of acute pancreatitis against international guidelines, and to assess temporal trends over the past 20 years.
A prospective four-month audit of patients with acute pancreatitis was performed across the Wessex region. The Atlanta 2012 classifications were used to define cases, severity and complications. Outcomes were recorded using validated systems and correlated against guideline standards. Case ascertainment was validated with clinical coding and hospital episode statistics data.
A total of 283 patient admissions with acute pancreatitis were identified. Aetiology included 153 gallstones (54%), 65 idiopathic (23%), 29 alcohol (10%), 9 endoscopic retrograde cholangiopancreatography (3%), 6 drug related (2%), 5 tumour (2%) and 16 other (6%). Compliance with guidelines had improved compared with our previous regional audit. Results were 6.5% mortality, 74% severity stratification, 23% idiopathic cases, 65% definitive treatment of gallstones within 2 weeks, 39% computed tomography within 6-10 days of severe pancreatitis presentation and 82% severe pancreatitis critical care admission. The Atlanta 2012 severity criteria significantly correlated with critical care stay, length of stay, development of complications and mortality (2% vs 6% vs 36%, < 0.0001).
The incidence of acute pancreatitis in southern England has risen substantially. The Atlanta 2012 classification identifies patients with severe pancreatitis who have a high risk of fatal outcome. Acute pancreatitis management is seen to have evolved in keeping with new evidence and updated clinical guidelines.
急性胰腺炎是一种常见的外科急症。识别其临床表现、发病率及治疗方法的差异，有助于护理的标准化和优化。本研究的目的是对照国际指南记录急性胰腺炎目前的发病率、治疗情况及预后，并评估过去20年的时间趋势。
对韦塞克斯地区的急性胰腺炎患者进行了为期四个月的前瞻性审计。采用2012年亚特兰大分类法来定义病例、严重程度和并发症。使用经过验证的系统记录预后，并与指南标准进行对比。通过临床编码和医院病历统计数据对病例确诊进行验证。
共确定了283例急性胰腺炎患者入院病例。病因包括153例胆结石（54%）、65例特发性（23%）、29例酒精性（10%）、9例内镜逆行胰胆管造影术相关（3%）、6例药物相关（2%）、5例肿瘤相关（2%）和16例其他原因（6%）。与我们之前的地区审计相比，对指南的依从性有所提高。结果显示死亡率为6.5%，严重程度分层率为74%，特发性病例占23%，2周内胆结石确诊治疗率为65%，重症胰腺炎出现后6 - 10天内计算机断层扫描使用率为39%，重症胰腺炎重症监护病房收治率为82%。2012年亚特兰大严重程度标准与重症监护病房住院时间、住院时长、并发症发生及死亡率显著相关（2%对6%对36%，<0.0001）。
英格兰南部急性胰腺炎的发病率大幅上升。2012年亚特兰大分类法可识别出重症胰腺炎患者，这些患者有较高的致命结局风险。急性胰腺炎的治疗已根据新证据和更新的临床指南有所发展。
