摘要 目的研究胰腺坏死组织感染(IPN)病人并发十二指肠瘘的诊治以及预后情况。方法回顾性分析2018年1月至2019年12月东部战区总医院重症胰腺炎治疗中心510例IPN病人资料,其中并发十二指肠瘘病人46例,按照倾向性评分(卡钳值0.2)进行1∶1匹配,将其与非十二指肠瘘病人进行1∶1匹配分析。结果IPN并发十二指肠瘘的发生率为9.0%(46/510)。76.1%十二指肠瘘通过窦道造影确诊;十二指肠瘘主要发生在十二指降部或升部,占91.2%;鼻肠管可以解决绝大部分(91.4%)十二指肠瘘病人的营养通路问题。非手术干预治愈率达97.82%。倾向性评分分析结果表明与IPN未并发十二指肠瘘病人相比,并发十二指肠瘘病人的住院时间更长[(40.93±34.02)d vs.(29.35±19.40)d,P=0.048],腹腔出血发生比例较高[20例(43.5%)vs.11例(23.9%),P=0.047];但在全身并发症急性呼吸窘迫综合征(ARDS)[29例(61.7%)vs.24例(52.1%),P=0.291]、AKI[22例(46.8%)vs.23例(50.0%),P=0.835]发生率和死亡率[7例(15.2%)vs.6例(13.0%),P=0.765]方面差异均无统计学意义。结论窦道造影是IPN并发十二指肠瘘的主要诊断方式;非手术治疗是十二指肠瘘的主要治愈方式;IPN并发十二指肠瘘病人的住院时间更长,出血发生率更高。 ObjectiveTo investigate the diagnosis,treatment and clinical prognosis of duodenal fistula in severe acute pancreatitis patients(SAP)with infected pancreatic necrosis(IPN).MethodsThe clinical records of 510 IPN patients admitted between January 2018 and December 2019 at Severe Acute Pancreatitis Treatment Center,General Hospital of Eastern Theater Command were analyzed retrospectively.Among them,the records of 46 patients who had got duodenal fistula with infected IPN were performed for propensity score matching(1∶1).ResultsOf the patients,duodenal fistula was present in 46(9.0%).The main diagnostic process of duodenal fistula in patients with IPN were fistulography by drainage tube which account for 76.1%.Most duodenal fistulas(91.2%)occurred in the descending or ascending part of the duodenum,and most duodenal fistulas(91.4%)could be solved by naso-intestinal tube for nutrition.Compared with severe pancreatitis IPN without duodenal fistula,duodenal fistula had a longer hospital stay[(40.93±34.02)vs.(29.35±19.4),P=0.048],and more abdominal hemorrhage[20(43.5%)vs.11(23.9%),P=0.047].There was no significant difference in ARDS[29(61.7%)vs.24(52.1%),P=0.291],AKI[22(46.8%)vs.23(50.0%),P=0.835],and mortality[7(15.2%)vs.6(13.0%),P=0.765].ConclusionThe main diagnostic process of duodenal fistula in IPN patients is fi stulography.The leading treatment is to adjust the position of the naso-intestinal tube for enteral nutrition and drainage strategy.Compared with none fistula with IPN,there is no statistical difference in systemic complications and mortality except for higher abdominal hemorrhage rate and longer hospital days.
机构地区 南京大学医学院附属金陵医院
出处 《中国实用外科杂志》 CAS CSCD 北大核心 2021年第3期315-319,共5页 Chinese Journal of Practical Surgery
基金 国家自然科学基金面上项目(No.81670588)。
分类号 R6 [医药卫生—外科学]
