真菌感染性胰腺坏死的临床分析:附46例报告

Clinical analysis of fungal infected pancreatic necrosis: a report of 46 cases

目的:分析真菌感染性胰腺坏死(IPN)的发病情况以及外科治疗与临床转归。方法:回顾2010年1月—2018年7月间中南大学湘雅医院胰胆外科连续收治的145例IPN患者的临床资料,对其中真菌性IPN病例进行重点分析。结果:145例IPN中,真菌性IPN共46例(31.7%);年代分布分析显示,近2年(2017—2018)真菌性IPN所占比例最高,达40.7%;46例患者均为念珠菌感染,主要为白色念珠菌(25例次),其次为光滑念珠菌(14例次)和热带念珠菌(7例次)。46例患者中,41例采取升阶梯治疗,5例采取降阶梯治疗。真菌性IPN患者的外科干预总次数159次,平均外科干预次数明显高于非真菌性IPN患者(3.5次/例vs. 2.7次/例,P<0.05)。全组IPN患者的病死率为22.1%(32/145),其中真菌性IPN患者的病死率为17.3%(8/46),非真菌性IPN患者为24.2%(24/99),两者差异无统计学意义(P>0.05)。46例患者中,4例患者合并真菌血症,合并真菌血症者的病死率较非真菌血症的病死率明显增高[75%(3/4)vs.14.3%(5/42),P<0.05]。结论:真菌性IPN的发病率呈上升趋势。虽然真菌感染并不增加IPN患者的病死率,但往往需要更多的外科干预,且当合并真菌血症时,患者的病死率明显升高。因此,合理选用抗真菌药物及彻底的感染源控制是治疗真菌性IPN的关键。

Objective： To analyze the morbidity situation of treatment and clinical outcomes. fungal infected pancreatic necrosis （IPN） as well as its surgical Methods： The clinical data of 145 consecutive patients with IPN treated in Xiangya Hospital of Central South University from January 2010 to July 2018 were retrospectively analyzed, with a particular focus on those associated with fungal IPN. Results： Of the 145 IPN patients, a total of 46 cases were fungal IPN （31.7%）; the results of time distribution analysis showed that fungal IPN had the highest proportion in the last two years （2017 to 2018）, which reached 40.7%; all the 46 patients were monilial infections, which were caused mainly by monilia albicans （25 cases）, secondly by candida alhicans （14 cases） and thirdly by candida tropicalis （7 cases）. Of the 46 patients, 41 cases underwent step-up treatment approach and 5 cases received step-down treatment approach. In fungal IPN patients, the number of total surgical interventions was 159 times, and the average number of surgical interventions was significantly higher than that in non-fungal IPN patients （3.5 times per case vs. 2.7 times per case, P〈0.05）. The mortality rate in the entire group of patients was 22.1% （32/145）, which in fungal IPN patients was 17.3% （8/46） and in non-fungal IPN patients was 24.2% （24/99）, and the difference had no significance （P〉0.05）. Of the 46 patients, 4 cases had concomitant bloodstream fi.mgal infection, in whom, the mortality rate was significantly higher than that in those without bloodstream fungal infection [75% （3/4） vs. 14.3% （5/42）, P〈0.05]. Conclusion： The incidence of fungal IPN exhibits a rising trend. Although fungal infection does not increase the mortality in IPN patients, it always requires more surgical interventions, and the mortality is significantly increased when combined with bloodstream fungal infection. Thus, proper selection of antifungal agents and thorough control of the source of infection are the essential prerequisites for successful treatment of funsal IPN.