Rana Surinder S, Bush Nikhil, Kang Mandeep, Gupta Rajesh
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh, India.
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
J Gastrointestin Liver Dis. 2022 Mar 19;31(1):60-66. doi: 10.15403/jgld-4045.
Previous studies have shown that patients with extra-pancreatic necrosis (EPN) alone are associated with better outcomes than patients with pancreatic necrosis (PN) in acute pancreatitis (AP). The natural history and drainage outcome of pancreatic collections resulting from PN vs. EPN has not been studied.
Clinical records of a prospectively maintained cohort of AP patients who underwent endoscopic drainage of walled of necrosis (WON) were reviewed. Computed tomography (CT) done on day 4 to 7 of illness was reviewed to identify EPN alone (Group 1) or PN with or without EPN (Group 2). Group 1 and 2 were compared for WON characteristics, as well as outcome and adverse effects of endoscopic drainage.
Seventy-one patients in Group 2 (57 males; mean age 38.6±11.5 years) were compared with sixteen patients in Group 1 (12 males; mean age 34.5±10.8 years). WON developing in Group 2 were significantly larger (11.7±2.8 cm vs. 9.5±2.03 cm) with higher solid necrotic debris (30.4±9.8% vs. 13.7±7.2%). Endoscopic transmural drainage of WON associated with PN required a greater number of direct endoscopic necrosectomy (DEN) sessions along with a longer time for resolution. The time taken for resolution correlated with size (r=0.629, p <0.01) and solid debris content (r=0.647, p<0.01), which were significantly higher in the PN group.
This new entity of walled of extra pancreatic necrosis alone has lesser solid necrotic debris and its endoscopic drainage is associated with better outcomes as compared to patients with walled off pancreatic necrosis.
既往研究表明，在急性胰腺炎（AP）中，单纯胰腺外坏死（EPN）患者的预后优于胰腺坏死（PN）患者。PN与EPN所致胰腺积液的自然病程及引流效果尚未得到研究。
回顾了一组前瞻性维持的AP患者队列的临床记录，这些患者接受了有壁坏死（WON）的内镜引流。对发病第4至7天进行的计算机断层扫描（CT）进行回顾，以识别单纯EPN（第1组）或伴有或不伴有EPN的PN（第2组）。比较第1组和第2组的WON特征，以及内镜引流的结局和不良反应。
第2组71例患者（57例男性；平均年龄38.6±11.5岁）与第1组16例患者（12例男性；平均年龄34.5±10.8岁）进行比较。第2组出现的WON明显更大（11.7±2.8 cm对9.5±2.03 cm），实性坏死碎片更多（30.4±9.8%对13.7±7.2%）。与PN相关的WON的内镜经壁引流需要更多次数的直接内镜坏死组织清除术（DEN），且 resolution所需时间更长。resolution所需时间与大小（r=0.629，p<0.01）和实性碎片含量（r=0.647，p<0.01）相关，PN组这些指标明显更高。
这种单纯胰腺外有壁坏死的新实体实性坏死碎片较少，与有壁胰腺坏死患者相比，其内镜引流的结局更好。
