感染性胰腺坏死及其合并肠瘘的临床分析

Clinical analysis of infected pancreatic necrosis and infected pancreatic necrosis complicated with intestinal fistula

目的:探讨感染性胰腺坏死(IPN)及其合并肠瘘的临床特点、诊治与转归。方法:回顾性分析2010年1月—2014年12月收治的33例IPN患者临床资料,其中10例合并肠瘘。结果:所有患者均按急性胰腺炎诊治指南行规范化治疗,肠瘘患者根据具体情况行肠瘘修补、肠瘘切除吻合术及腹腔引流;全组IPN患者的病死率为39.4%(13/33),2012版急性胰腺炎严重程度分级与IPN患者死亡密切相关(P<0.05);IPN合并肠瘘患者的病死率为40.0%(4/10),肠瘘对IPN总体病死率无明显影响(P>0.05),但明显延长患者的住院时间(P<0.05)。罕见部位肠瘘患者的病死率(75.0%,3/4)高于常见部位肠瘘患者(16.7%,1/6)(P<0.05)。结论:IPN有较高的病死率,肠瘘发生虽不明显增加IPN患者的总体病死率,但却明显影响患者恢复,而且罕见部位肠瘘能增加患者的病死率。

Objective：To investigate the clinical features,diagnosis and treatment as well as outcomes of infected pancreatic necrosis（IPN） and IPN complicated with intestinal fistula.Methods：The clinical data of 33 IPN patients,including 10 cases complicated with intestinal fistula,admitted from January 2010 to December 2014 were retrospectively analyzed.Results：All patients underwent standardized treatment in accordance with acute pancreatitis diagnosis and treatment guideline,and patients with intestinal fistula had additional fistula repair or fistula resection and anastomosis,and peritoneal drainage according to the specific conditions.The mortality of the entire group of 33 patients was 39.4%（13/33）,and the severity score（2012） was closely associated with the mortality（P〈0. 05）.The mortality of those complicated with intestinal fistula was 40.0%（4/10）,and intestinal fistula exerted no impact on the overall mortality（P〈0. 05）,but significantly prolonged the hospital stay of the patients（P〉0. 05）.The mortality in patients with intestinal fistula located in uncommon sites（75%,3/4） was higher than that in patients with intestinal fistula located in common sites（16.7%,1/6）（P〈0. 05）.Conclusion：IPN has a relatively high mortality,and although intestinal fistula does not obviously increase mortality of IPN patients,it significantly influences the recovery of the patients,and intestinal fistula in an uncommon site may increase the mortality of the patients.