摘要
目的:探讨CT评判急性胰腺炎(AP)合并局限性和广泛性胰周组织坏死(PPN)的临床意义。方法:回顾性分析2016-07—2019-06期间收治的126例经CT证实合并PPN的AP患者的临床和影像学资料,根据CT评估将其分为局限性(最大横径≤5 cm且累及部位≤3个)和广泛性(最大横径>5 cm或累及部位>3个)PPN,对比分析以上两种类型PPN患者的一般资料、临床和预后指标。结果:本组126例合并PPN的AP患者中,局限性PPN占65.1%(82/126),广泛性PPN占34.9%(44/126)。局限性和广泛性PPN患者在器官功能衰竭发生率、ICU入住率、病死率等指标方面均差异无统计学意义(P>0.05)。但广泛性PPN发病1周时改良CT严重指数(MCTSI)评分较高(P<0.05),整个病程中合并胸腔积液和腹腔积液的比例较高(P<0.05),持续性器官功能衰竭、多器官功能衰竭、坏死组织感染比例较高(P<0.05),需要有创干预的比例较高(P<0.05),ICU住院天数、总住院天数较长(P<0.05)。结论:CT评判标准下的局限性和广泛性PPN具有不同的临床预后特征,局限性PPN病情较轻,通常无需有创干预;而广泛性PPN患者局部和全身并发症较多,CT评判标准在PPN临床诊治过程中具有指导意义。
Objective: To investigate the clinical significance of CT in the evaluation of limited and extensive peripancreatic necrosis(PPN) in acute pancreatitis(AP). Method: The clinical and imaging data of 126 cases of PPN in AP confirmed by CT from July 2016 to June 2019 were retrospectively analyzed. According to CT evaluation, PPN were divided into limited(maximum transverse diameter ≤ 5 cm and involvement locations ≤ 3) and extensive(maximum transverse diameter>5 cm or involvement locations>3). The general data, clinical and prognostic indicators of the two types of PPN were compared and analyzed. Result: Of the 126 AP patients with PPN, 65.1%(82/126) were limited PPN and 34.9%(44/126) were extensive PPN. There were no significant differences in the incidence of organ failure, ICU occupancy rate and mortality between patients with limited and extensive PPN(P>0.05). However, in patients with extensive PPN, the modified CT severity index(MCTSI) score at the 1 week after the onset was higher(P<0.05), the proportions of pleural effusion and ascites were higher in the whole course of the disease(P<0.05). The proportions of persistent organ failure, multiple organ failure and necrotic tissue infection in patients with extensive PPN were higher(P<0.05), the proportion of invasive intervention were higher(P<0.05), and the length of stay in ICU and the length of stay in hospital were longer(P<0.05). Conclusion: The limited and extensive PPN under CT evaluation criteria have different clinical prognosis characteristics. Limited PPN is mild and usually does not require invasive intervention, while extensive PPN patients have more local and systemic complications. CT evaluation classification has guiding significance for clinical diagnosis and treatment of PPN.
作者
陈兰兰
陶超超
许尚文
郭嘉菁
CHEN Lanlan;TAO Chaochao;XU Shangwen;GUO Jiajing(Department of Medical Imaging,the 900th Hospital of the Joint Logistics Team,Fuzhou,350025,China)
出处
《临床急诊杂志》
CAS
2020年第2期157-160,164,共5页
Journal of Clinical Emergency
基金
福建省自然科学基金项目(No:2015J01490).
关键词
急性坏死性胰腺炎
胰周组织坏死
CT
acute necrotizing pancreatitis
peripancreatic necrosis
computed tomography
作者简介
通信作者:郭嘉菁,E-mail:3088145978@qq.com
