急性胰腺炎合并感染性坏死经皮置管引流后开腹手术干预的危险因素分析

Risk factors for the need of surgical necrosectomy after percutaneous catheter drainage in the management of acute pancreatitis with infected necrosis

目的分析经皮穿刺置管引流术(percutaneous catheter drainage,PCD)治疗急性胰腺炎合并感染性坏死后仍需外科手术干预的危险因素。方法采用回顾性病例对照研究的方法。收集2008年9月至2018年4月第四军医大学西京消化病医院收治的321例行PCD治疗的急性胰腺炎合并感染性坏死病人的病例资料。采用Logistic回归模型分析PCD后仍需外科手术干预的独立危险因素。结果纳入的321例病人中,234例通过PCD治愈,87例需进一步手术干预。单因素分析结果显示:CT严重指数(CTSI)、多脏器衰竭、胰腺坏死范围、延迟肠内营养、多重耐药菌感染是PCD后需手术干预的相关因素(P<0.05)。多因素分析结果显示:CTSI、多脏器衰竭、胰腺坏死范围>50%、多重耐药菌感染是PCD后需手术干预的独立危险因素(P<0.05)。结论部分急性胰腺炎合并感染性坏死的病人可通过PCD治愈从而避免外科手术干预。CTSI、多器官功能衰竭、引流液多重耐药菌感染、胰腺坏死面积>50%是PCD后需手术干预的独立危险因素。

Objective To analyze the risk factors of the need of surgical necrosectomy after percutaneous catheter drainage (PCD) for acute pancreatitis with infected necrosis. Methods A retrospective case-control study was conducted. The clinical data of 321 patients who were treated with PCD in Xijing Hospital of Digestive Diseases,Fourth Military Medical University from September 2008 to April 2018 were extracted and analyzed. Multivariate analysis was conducted with the binary logistic regression model to identify independent risk factors. Results Of 321 patients enrolled,234 cases were cured by PCD alone and 87 cases need surgical necrosectomy. Univariate analysis showed that computed tomography severity index (CTSI),multiple-organ failure,high percentage of necrosis,delayed enteral nutrition and multidrug-resistant bacteria infection were related factors for the need of surgical necrosectomy ( P <0.05). Multivariate analysis showed that CTSI,multiple-organ failure,high percentage of necrosis (>50%) and multidrug-resistant bacteria infection were independent risk factors for the need of surgical necrosectomy after PCD. Conclusion Some patients with acute pancreatitis and infectious necrosis can be cured by PCD,thereby precluding surgical intervention. CTSI,multiple-organ failure,high percentage of necrosis (>50%) and multidrug-resistant bacteria infection were independent risk factors for the need of necrosectomy after PCD.