Department of Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Department of Radiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Medicina (Kaunas). 2022 May 8;58(5):645. doi: 10.3390/medicina58050645.
Background and Objectives: The course and clinical outcomes of acute pancreatitis (AP) are highly variable. Up to 20% of patients develop pancreatic necrosis. Extent and location of it might affect the clinical course and management. The aim was to determine the clinical relevance of the extent and location of pancreatic necrosis in patients with AP. Materials and Methods: A cohort of patients with necrotizing AP was collected from 2012 to 2018 at the Hospital of Lithuanian University of Health Sciences. Patients were allocated to subgroups according to the location (entire pancreas, left and right sides of pancreas) and extent (<30%, 30−50%, >50%) of pancreatic necrosis. Patients were reviewed for demographic features, number of performed surgical interventions, local and systemic complications, hospital stay and mortality rate. All contrast enhanced computed tomography (CECT) scans were evaluated by at least two experienced abdominal radiologists. All patients were treated according to the standard treatment protocol based on current international guidelines. Results: The study included 83 patients (75.9% males (n = 63)) with a mean age of 53 ± 1.7. The volume of pancreatic necrosis exceeded 50% in half of the patients (n = 42, 51%). Positive blood culture (n = 14 (87.5%)), multiple organ dysfunction syndrome (n = 17 (73.9%)) and incidences of respiratory failure (n = 19 (73.1%)) were significantly more often diagnosed in patients with pancreatic necrosis exceeding 50% (p < 0.05). Patients with >50% of necrosis were significantly (p < 0.05) more often diagnosed with moderately severe (n = 24 (41.4%)) and severe (n = 18 (72%)) AP. The number of surgical interventions (n = 18 (72%)) and ultrasound-guided interventions (n = 26 (65%)) was also significantly higher. In patients with whole-pancreas necrosis, incidence of renal insufficiency (n = 11 (64.7%)) and infected pancreatic necrosis (n = 19 (57.6%)) was significantly higher (p < 0.05). Conclusions: The clinical course and outcome were worse in the case of pancreatic necrosis exceeding 50%, rendering the need for longer and more complex treatment.
急性胰腺炎（AP）的病程和临床结局差异很大。多达 20%的患者会发生胰腺坏死。坏死的范围和部位可能会影响临床病程和治疗方式。本研究旨在确定 AP 患者胰腺坏死范围和部位的临床相关性。
本研究收集了 2012 年至 2018 年立陶宛健康科学大学附属医院坏死性 AP 患者的队列。根据胰腺坏死的部位（整个胰腺、胰腺左侧和右侧）和程度（<30%、30-50%、>50%）将患者分为亚组。回顾患者的人口统计学特征、手术干预次数、局部和全身并发症、住院时间和死亡率。所有增强 CT 扫描（CECT）均由至少两位有经验的腹部放射科医生进行评估。所有患者均根据当前国际指南的标准治疗方案进行治疗。
本研究纳入 83 例患者（75.9%为男性（n = 63）），平均年龄为 53 ± 1.7 岁。一半以上患者的胰腺坏死体积超过 50%（n = 42，51%）。胰腺坏死体积超过 50%的患者中，血培养阳性（n = 14（87.5%））、多器官功能障碍综合征（n = 17（73.9%））和呼吸衰竭发生率（n = 19（73.1%））明显更高（p < 0.05）。胰腺坏死体积超过 50%的患者更常被诊断为中度严重（n = 24（41.4%））和严重（n = 18（72%））AP（p < 0.05）。需要手术干预（n = 18（72%））和超声引导干预（n = 26（65%））的患者也明显更多。全胰腺坏死患者中，肾功能不全发生率（n = 11（64.7%））和感染性胰腺坏死发生率（n = 19（57.6%））明显更高（p < 0.05）。
胰腺坏死体积超过 50%的患者临床病程和结局更差，需要更长、更复杂的治疗。
