急性坏死性胰腺炎CT诊断分型的临床意义

Clinical Significance of CT Classification of Acute Necrotizing Pancreatitis

目的 探讨急性坏死性胰腺炎CT诊断分型的临床意义。方法 选取2016年7月至2021年6月收治的CT诊断为急性坏死性胰腺炎的127例患者的临床和影像资料,对患者住院期间历次CT检查图像进行重新阅片,参照国际结构化CT报告模板标准,根据坏死灶分布和位置不同划分为胰腺坏死型、胰周坏死型、胰腺坏死+胰周坏死型(混合型)3种亚型,对比3种亚型患者一般资料、坏死组织继发感染发生率、器官衰竭发生率、持续性器官衰竭发生率、有创干预比例、入住ICU比例、入住ICU天数、病死率等临床指标。使用SPSS21.0统计学软件,多组间比较采用单因素方差分析或卡方检验,两两比较分别选择最小显著差异法(LSD)和Bonferroni法。结果 本组127例急性坏死性胰腺炎中胰腺坏死型、胰周坏死型和混合型所占比例分别为7.9%(10/127)、20.5%(26/127)和71.6%(91/127),3种亚型坏死组织继发感染发生率(χ^(2)=7.811, P=0.020)、器官衰竭发生率(χ^(2)=7.098, P=0.029)、持续性器官衰竭发生率(χ^(2)=9.443, P=0.009)、入住ICU比例(χ^(2)=6.019, P=0.049)、入住ICU天数(F=16.272, P<0.001)、病死率(χ^(2)=7.340, P=0.025)方面组间差异具有统计学意义(P<0.05),胰腺坏死型和混合型上述指标均显著高于胰周坏死型(P<0.05),胰腺坏死型和混合型上述指标两组间差异未见统计学意义(P>0.05)。3种亚型有创干预率差异无统计学意义(χ^(2)=3.947, P=0.137)。结论 CT诊断分型对急性坏死性胰腺炎严重程度和预后评估具有重要意义。

Objective To investigate the clinical significance of CT classification of acute necrotizing pancreatitis.Methods The clinical and imaging data of 127 patients with acute necrotizing pancreatitis treated from July 2016 to June 2021 were selected.The CT images of patients during hospitalization were re read.According to the distribution and location of necrotic foci,they were divided into three subtypes:pancreatic necrosis type,peripancreatic necrosis type,pancreatic necrosis+peripancreatic necrosis type(mixed type).The general data of patients with the three subtypes were compared The incidence of secondary infection of necrotic tissue,the incidence of organ failure,the incidence of persistent organ failure,the proportion of invasive intervention,the proportion of admission to ICU,the number of days in ICU,mortality and other clinical indicators.Spss21.0 statistical software was used.One way ANOVA or chi square test was used for multi group comparison.The least significant difference method(LSD)and Bonferroni method were selected for pairwise comparison.Resluts in 127 cases of acute necrotizing pancreatitis,the proportions of Pancreatic Necrotic type,peripancreatic necrotic type and mixed type were 7.9%(10/127),20.5%(26/127)and 71.6%(91/127),respectively.The incidence of secondary infection of three subtypes of necrotic tissue was high(χ^(2)=7.811,P=0.020),incidence of organ failure(χ^(2)=7.098,P=0.029).Incidence of persistent organ failure(χ^(2)=9.443,P=0.009).Proportion of admission to ICU(χ^(2)=6.019,P=0.049),days in ICU(F=16.272,P<0.001),mortality(χ^(2)=7.340,P=0.025).The above indexes of pancreatic necrosis and mixed type were significantly higher than those of peripancreatic necrosis(P<0.05).There was no significant difference between the two groups(P>0.05).There was no significant difference in invasive intervention rate among the three subtypes(χ^(2)=3.947,P=0.137).Concoloins CT classification is of great significance in evaluating the severity and prognosis of acute necrotizing pancreatitis.