Fusco Stefano, Hanke Greta M, Büringer Karsten, Minn Lisa, Blumenstock Gunnar, Schempf Ulrike, Götz Martin, Malek Nisar P, Wichmann Dörte, Werner Christoph R
Section of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology and Geriatrics, Department of Internal Medicine I, University Hospital of Tübingen, Otfried-Müller-Str. 10, Tübingen 72076, Germany.
Department of Nephrology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
Therap Adv Gastroenterol. 2024 Nov 23;17:17562848241301945. doi: 10.1177/17562848241301945. eCollection 2024.
The acute and chronic pancreatitis (CP) can lead to severe complications like walled-off necrosis, large symptomatic pseudocyst or multiorgan failure. The treatment of these complications is multivariate and can differ from conservative, symptomatic treatment or minimal-invasive, endoscopic transgastral stenting to transgastral necrosectomy.
This study aims to analyse the clinical course for patients that develop local complications of severe pancreatitis.
This is a retrospective observational single-centre study on 46 patients with severe pancreatitis.
In this retrospective single-centre study, 46 out of 474 inpatients from January 2014 to December 2020, who were treated because of an acute or CP, developed acute pancreatitis complications and could be included. We analysed and compared the clinical course of different treatments (lumen apposing metal stents, transgastral double pigtail stent, endoscopic retrograde cholangiopancreatography, operation, conservative treatment) and different complications (walled-off necrosis (WON), pancreatic pseudocyst (PPC)).
Forty-six patients developed an acute complication due to severe pancreatitis. Twenty-seven patients developed a WON, while 19 patients suffered from PPC. 48% of the whole cohort had an alcoholic aetiology of pancreatitis. 78% were treated with antibiotics, 48% suffered from infected pancreatitis and 22% needed intensive care treatment. WON patients more often had a longer hospitalization of more than 21 days. PPC patients were correlated with an alcoholic aetiology, whereas WON patients were inversely correlated with an alcoholic aetiology. Increased lactate dehydrogenase, lipase, and C-reactive protein levels as well as leucocyte count could be associated with a higher probability to exhibit a WON instead of another local complication. The mortality rate was low with 7% in our study.
WON and PPC differ in certain patients and laboratory characteristics such as aetiology, elevated laboratory values, antibiotic treatment or the duration of hospitalization. Invasive treatment is not required in all severe pancreatitis cases.
急性和慢性胰腺炎（CP）可导致严重并发症，如包裹性坏死、大型有症状假性囊肿或多器官功能衰竭。这些并发症的治疗是多方面的，可能不同于保守的对症治疗、微创的内镜经胃支架置入术或经胃坏死组织清除术。
本研究旨在分析发生严重胰腺炎局部并发症患者的临床病程。
这是一项对46例严重胰腺炎患者进行的回顾性观察单中心研究。
在这项回顾性单中心研究中，2014年1月至2020年12月期间因急性或慢性胰腺炎接受治疗的474例住院患者中有46例发生了急性胰腺炎并发症并被纳入研究。我们分析并比较了不同治疗方法（管腔贴附金属支架、经胃双猪尾支架、内镜逆行胰胆管造影、手术、保守治疗）和不同并发症（包裹性坏死（WON）、胰腺假性囊肿（PPC））的临床病程。
46例患者因严重胰腺炎出现急性并发症。27例患者发生了包裹性坏死，而19例患者患有胰腺假性囊肿。整个队列中有48%的患者胰腺炎病因是酒精性的。78%的患者接受了抗生素治疗，48%的患者患有感染性胰腺炎，22%的患者需要重症监护治疗。发生包裹性坏死的患者住院时间超过21天的情况更常见。胰腺假性囊肿患者与酒精性病因相关，而包裹性坏死患者与酒精性病因呈负相关。乳酸脱氢酶、脂肪酶和C反应蛋白水平升高以及白细胞计数增加可能与发生包裹性坏死而非其他局部并发症的可能性更高有关。我们研究中的死亡率较低，为7%。
在某些患者以及病因、实验室值升高、抗生素治疗或住院时间等实验室特征方面，包裹性坏死和胰腺假性囊肿存在差异。并非所有严重胰腺炎病例都需要进行侵入性治疗。
