摘要
目的了解修订版亚特兰大分类标准下急性胰腺炎(AP)局部并发症的转归,探讨CT检查预测局部并发症转归的价值。方法回顾性分析2012年1月至2015年7月间163例急性胰周液体积聚(APFC)及84例急性坏死性积聚(ANC)患者的病历资料。28例APFC和41例ANC分别进展为胰腺假性囊肿(PP)和包裹性坏死(WON);19例患者合并局部感染。采用SPSS 17.0进行数据分析,比较PP组与APFC吸收组、WON组与ANC吸收组、局部并发症感染组与未感染组的组间差异。绘制受试者工作特征(ROC)曲线,判断其预测准确性。结果 PP组与APFC吸收组间积液分布范围、计算机断层扫描下胰周炎症(EPIC)评分有统计学差异;WON组与ANC吸收组间有差异的指标包括胰腺炎症部位、坏死累及胰腺、坏死面积、EPIC评分、计算机断层扫描严重指数(CTSI);感染组与未感染组间的肾前筋膜增厚、胰腺或胰周坏死、EPIC评分、CTSI有明显差异。积液分布范围预测APFC不吸收的准确性最高,EPIC评分预测ANC不吸收及局部并发症感染的准确性最高。结论大多数APFC自行吸收,约半数ANC自行吸收,局部并发症感染率较低。多个CT指标可用于预测局部并发症的转归。应重视EPIC评分的临床价值。
Objective To understand the prognosis of local complications in patients with acute pancreatitis（AP） under revised Atlanta classification,and explore the value of CT in predicting prognosis of local complications. Methods We retrospectively analyzed the medical records of 163 patients with acute peripancreatic fluid collections（APFC） and 84 patients with acute necrotic collection（ANC） between January2012 and July 2015. 28 APFCs and 41 ANCs evolved into pancreatic pseudocyst（PP） and walled-off necrosis（WON） respectively; 19 patients were diagnosed with local infection. SPSS 17 was used to justify the difference between PP group and APFC-absorption group,WON group and ANC-absorption group,local complication infection group and non-infection group. Receiver operating characteristic（ROC） analysis was applied to justify the predicting accuracy according to area under curve. Results There was statistically difference in distribution of abdominal fluids and extrapancreatic inflammation on CT（EPIC） between PP group and APFC-absorption group. While the difference between WON group and ANC-absorption group included location of pancreatitis, necrosis involving pancreas and necrosis area, EPIC and computer tomography severity index（CTSI）. Also,there was significant difference in pre-renal fascial thickening,necrosis of pancreas or peri-pancreas tissue,EPIC,CTSI between patients with and without local infection.Distribution of abdominal fluids had highest accuracy in predicting APFC non-absorption,while EPIC had highest accuracy in predicting ANC non-absorption and local infection. Conclusion Majority of APFCs absorbed,and almost half of ANCs absorbed,and local infection occurred in few patients. Several markers under CT could be used to predict the progress of local complications. Attention should be paid to the clinical value of EPIC.
出处
《中华普外科手术学杂志（电子版）》
2017年第4期285-288,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
首都临床特色应用研究与成果推广
项目编号:Z171100001017077~~
