经皮内镜下清创感染性胰腺坏死组织失败危险因素分析

Analysis of risk factors for failure of percutaneous endoscopic necrosectomy in patients with infected pancreatic necrosis

目的探讨影响感染性胰腺坏死(IPN)病人经皮内镜下清创(PEN)治疗失败的风险因素。方法回顾性分析2017年1月至2017年12月中国人民解放军东部战区总医院重症急性胰腺炎中心诊治的56例IPN病人临床资料,根据是否接受开放手术以及死亡的结局,分为PEN成功组(42例)与PEN失败组(14例)。观察比较两组病人入院临床特征、清创操作步骤及预后,并对影响PEN失败的相关因素进行单因素分析和多因素分析。结果PEN总体成功率为75.0%。与PEN成功组相比,PEN失败组入院时急性生理及慢性健康状况Ⅱ(APACHEⅡ)评分、序贯器官功能衰竭(SOFA)评分,持续器官功能衰竭比例、使用机械通气和血管活性药物使用率的病人比例均更高(P均<0.05);但PEN失败组的IPN诊断距发病病程、首次PEN距发病病程均更短(P<0.05),增强CT影像学特征中边界清晰和气泡征的病人比例更低(P<0.05)。单因素分析结果显示APACHEⅡ评分、SOFA评分、机械通气、血管活性药物、IPN诊断距发病病程、首次PEN距发病病程、首次PEN距发病病程,边界清晰和气泡征的增强CT影像学征象与PEN失败相关(P<0.05)。多因素分析结果显示SOFA评分高是PEN失败的独立影响因素(P<0.05)。结论APACHEⅡ评分、SOFA评分、机械通气、血管活性药物、IPN诊断距发病病程、首次PEN距发病病程、增强CT影像学表现为即边界清晰和气泡征是PEN失败的危险因素,高SOFA评分是PEN失败独立危险因素。

ObjectiveTo explore the risk factors impacting clinical outcome of patients with infected pancreaticnecrosis(IPN)undergoing percutaneous endoscopic necrosectomy(PEN).MethodsA retrospective review of 56 IPNpatients who underwent at least one PEN from January 2017 to December 2017 in the center of severe acute pancreatitis,General Hospital of Eastern Theater Command was performed.According to the need for open necrosectomy andhospitalization mortality,the IPN patients were classified into two groups:the PEN success group(n=42)and the PENfailure group(n=14).The demographic characteristics at admission,endoscopic procedures and clinical outcomes ofenrolled patients were recorded and analyzed.Further univariate and multivariate logistic regression analysis were takento evaluate the risk factors for PEN failure.ResultsThe overall success rate of the patients was 75.0%.Compared withthe PEN success group,the patients in the PEN failure group had a higher APACHE II score,SOFA score and morepercents of persistent organ failure,application of mechanical ventilation and inotropic support at admission withsignificance(P<0.05).However,the duration from disease onset to IPN and to the first endoscopic treatment weresignificantly longer in the PEN success group than the PEN failure group(P<0.05).Clear boundaries and bubble sign inthe contrast-enhanced computed tomography(CECT)were found in more percents of thepatients of the PEN success group than the PENfailure group(P<0.05).Univariate logisticregression analysis indicated that significantassociations between PEN failure and APACHEⅡscore,SOFA score,mechanical ventilation,inotropic support,duration from AP onset to IPN and first PEN,and theclear boundaries and bubble sign on CECT imaging(P<0.05).Multivariate logistic regression analysis showed that highSOFA score was independently associated with PEN failure(P<0.05).ConclusionAPACHEⅡscore,SOFA score,mechanical ventilation,inotropic support,the duration from disease to IPN and to the first PEN and the clear boundariesand bubble sign on CECT imagine are found the risk factors.High SOFA score is found the independent risk factor.