Lu T Q, Shang L R, Bie F, Xu Y L, Sui Y H, Li G Q, Chen H, Wang G, Kong R, Bai X W, Tan H T, Wang Y W, Sun B
Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University,Key Laboratory of Hepatosplenic Surgery,Ministry of Education,Harbin 150001,China.
Zhonghua Wai Ke Za Zhi. 2023 Jan 1;61(1):33-40. doi: 10.3760/cma.j.cn112139-20220513-00221.
To explore the clinical characteristics of various types of infected pancreatic necrosis(IPN) and the prognosis of different treatment methods in the imaging classification of IPN proposed. The clinical data of 126 patients with IPN admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from December 2018 to December 2021 were analyzed retrospectively. There were 70 males(55.6%) and 56 females(44.4%), with age((IQR)) of 44(17)years (range: 12 to 87 years). There were 67 cases(53.2%) of severe acute pancreatitis and 59 cases (46.8%) of moderately severe acute pancreatitis. All cases were based on the diagnostic criteria of IPN. All cases were divided into Type Ⅰ(central IPN)(=21), Type Ⅱ(peripheral IPN)(=23), Type Ⅲ(mixed IPN)(=74) and Type Ⅳ(isolated IPN)(=8) according to the different sites of infection and necrosis on CT.According to different treatment strategies,they were divided into Step-up group(=109) and Step-jump group(=17). The clinical indicators and prognosis of each group were observed and analyzed by ANOVA,-test, test or Fisher exact test,respectively. There was no significant difference in mortality, complication rate and complication grade in each type of IPN(all >0.05). Compared with other types of patients, the length of stay (69(40)days 19(19)days) and hospitalization expenses(323 000(419 000)yuan 60 000(78 000)yuan) were significantly increased in Type Ⅳ IPN(=-4.041, -3.972; both <0.01). The incidence of postoperative residual infection of Type Ⅳ IPN was significantly higher than that of other types (=16.350,<0.01). There was no significant difference in the mortality of patients with different types of IPN between different treatment groups. The length of stay and hospitalization expenses of patients in the Step-up group were significantly less than those in the Step-jump group(19(20)days 33(35)days, =-2.052, =0.040;59 000(80 000)yuan 122 000(109 000)yuan,=-2.317,=0.020). Among the patients in Type Ⅳ IPN, the hospitalization expenses of Step-up group was significantly higher than that of Step-jump group(330 000(578 000)yuan 141 000 yuan,=-2.000,=0.046). The incidence of postoperative residual infection of Step-up group(17.4%(19/109)) was significantly lower than that of Step-jump group(10/17)(=11.980, =0.001). Type Ⅳ IPN is more serious than the other three types. It causes longer length of stay and more hospitalization expenses. The step-up approach is safe and effective in the treatment of IPN. However, for infected lesions which are deep in place,difficult to reach by conventional drainage methods, or mainly exhibit "dry necrosis", choosing the step-jump approach is a more positive choice.
为探讨不同类型感染性胰腺坏死（IPN）的临床特征以及IPN影像学分型中不同治疗方法的预后。回顾性分析2018年12月至2021年12月哈尔滨医科大学附属第一医院胰胆外科收治的126例IPN患者的临床资料。男性70例（55.6%），女性56例（44.4%），年龄（四分位间距）为44（17）岁（范围：12至87岁）。重症急性胰腺炎67例（53.2%），中度重症急性胰腺炎59例（46.8%）。所有病例均符合IPN诊断标准。根据CT上感染和坏死的不同部位，将所有病例分为Ⅰ型（中央型IPN）（=21例）、Ⅱ型（周围型IPN）（=23例）、Ⅲ型（混合型IPN）（=74例）和Ⅳ型（孤立型IPN）（=8例）。根据不同治疗策略，将其分为递进组（=109例）和跨越组（=17例）。分别采用方差分析、t检验、秩和检验或Fisher确切概率法观察分析各组的临床指标及预后。各型IPN的死亡率、并发症发生率及并发症分级差异均无统计学意义（均P>0.05）。与其他类型患者相比，Ⅳ型IPN患者的住院时间（69（40）天比19（19）天）和住院费用（323 000（419 000）元比60 000（78 000）元）显著增加（t=-4.041，t=-3.972；均P<0.01）。Ⅳ型IPN患者术后残余感染发生率显著高于其他类型（χ²=16.350，P<0.01）。不同治疗组间不同类型IPN患者的死亡率差异无统计学意义。递进组患者的住院时间和住院费用显著少于跨越组（19（20）天比33（35）天，t=-2.052，P=0.040；59 000（80 000）元比122 000（109 000）元，t=-2.317，P=0.020）。在Ⅳ型IPN患者中，递进组的住院费用显著高于跨越组（330 000（578 000）元比141 000元，t=-2.000，P=0.046）。递进组术后残余感染发生率（17.4%（19/109））显著低于跨越组（10/17）（χ²=11.980，P=0.001）。Ⅳ型IPN比其他三型更严重，导致住院时间更长、住院费用更多。递进式治疗方法治疗IPN安全有效。然而，对于位置深、常规引流方法难以到达或主要表现为“干坏死”的感染性病变，选择跨越式治疗方法是更积极的选择。
