Cao F, Lu J D, Li A, Zhang C, Wang Z, Gao C C, Wang X H, Li F
Department of General Surgery,Xuanwu Hospital,Capital Medical University,Clinical Center for Acute Pancreatitis,Capital Medical University,Beijing 100053,China.
Zhonghua Wai Ke Za Zhi. 2023 Jul 1;61(7):567-574. doi: 10.3760/cma.j.cn112139-20230318-00111.
To investigate the clinical characteristics of colon complications in patients with necrotizing pancreatitis(NP). The clinical data of 403 patients with NP admitted to the Department of General Surgery,Xuanwu Hospital, Capital Medical University from January 2014 to December 2021 were retrospectively analyzed. There were 273 males and 130 females,aged (49.4±15.4) years(range: 18 to 90 years). Among them,there were 199 cases of biliary pancreatitis,110 cases of hyperlipidemic pancreatitis,and 94 cases of pancreatitis caused by other causes. A multidisciplinary diagnosis and treatment model was used to diagnose and treat patients. Depending on whether the patients had colon complications,they were divided into colon complications group and noncolon complications group. Patients with colon complications were treated with anti-infection therapy,parental nutritional support,keeping the drainage tube unobstructed,and terminal ileostomy. The clinical results of the two groups were compared and analyzed using a 1∶1 propensity score match(PSM) method. The test, test, or rank-sum test was used to analyze data between groups,respectively. The incidence of colon complications was 13.2%(53/403),including 15 cases of colon obstruction,23 cases of colon fistula,and 21 cases of colon hemorrhage. After PSM,the baseline and clinical characteristics at admission of the two groups of patients were comparable (all >0.05). In terms of clinical outcome,compared to patients with NP without colon complications,the number of patients with colon complications who received minimally invasive intervention(88.7%(47/53) 69.8%(37/53),=5.736,=0.030),the number of minimally invasive interventions ((IQR))(2(2) 1(1), =4.638,=0.034),the number of patients with multiple organ failure(45.3%(24/53) 32.1%(17/53),=4.826,=0.041),and the number of extrapancreatic infections(79.2%(42/53) 60.4%(32/53),=4.476,=0.034) increased significantly. The time required for enteral nutrition support(8(30)days 2(10) days, =-3.048, =0.002), parental nutritional support(32(37)days 17(19)days, =-2.592, =0.009),the length of stay in the ICU(24(51)days 18(31)days, =-2.268, =0.002),and the total length of stay (43(52)days 30(40)days, =-2.589, =0.013) were also significantly prolonged. However,mortality rates in the two groups were similar(37.7%(20/53) 34.0%(18/53),=0.164,=0.840). Colonic complications in NP patients are not rare,which can lead to prolonged hospitalization and increased surgical intervention. Active surgical intervention can help improve the prognosis of these patients.
探讨坏死性胰腺炎（NP）患者结肠并发症的临床特征。回顾性分析2014年1月至2021年12月首都医科大学宣武医院普通外科收治的403例NP患者的临床资料。其中男性273例，女性130例，年龄（49.4±15.4）岁（范围：18至90岁）。其中胆源性胰腺炎199例，高脂血症性胰腺炎110例，其他原因所致胰腺炎94例。采用多学科诊疗模式对患者进行诊治。根据患者是否发生结肠并发症，将其分为结肠并发症组和无结肠并发症组。结肠并发症患者给予抗感染治疗、肠外营养支持、保持引流管通畅及末端回肠造口术。采用1∶1倾向评分匹配（PSM）法对两组患者的临床结果进行比较分析。分别采用t检验、χ²检验或秩和检验分析组间数据。结肠并发症发生率为13.2%（53/403），其中结肠梗阻15例，结肠瘘23例，结肠出血21例。PSM后，两组患者入院时的基线和临床特征具有可比性（均P>0.05）。在临床结局方面，与无结肠并发症的NP患者相比，发生结肠并发症的患者接受微创干预的例数（88.7%（47/53）比69.8%（37/53），χ²=5.736，P=0.030）、微创干预次数（四分位数间距）（2（2）比1（1），Z=4.638，P=0.034）、多器官功能衰竭例数（45.3%（24/53）比32.1%（17/53），χ²=4.826，P=0.041）及胰腺外感染例数（79.2%（42/53）比60.4%（32/53），χ²=4.476，P=0.034）均显著增加。肠内营养支持时间（8（30）天比2（10）天，t=-3.048，P=0.002）、肠外营养支持时间（32（37）天比17（19）天，t=-2.592，P=0.009）、入住重症监护病房（ICU）时间（24（51）天比18（31）天，t=-2.268，P=0.002）及总住院时间（43（52）天比30（40）天，t=-2.589，P=0.013）也均显著延长。然而，两组患者的死亡率相似（37.7%（20/53）比34.0%（18/53），χ²=0.164，P=0.840）。NP患者的结肠并发症并不少见，可导致住院时间延长和手术干预增加。积极的手术干预有助于改善这些患者的预后。
