单中心慢性胰腺炎的临床特征和治疗模式10年变迁

Clinical characteristics and treatment mode changes of chronic pancreatitis:a 10‐year single center study

目的探讨慢性胰腺炎(CP)的临床特征和治疗模式变迁。方法采用回顾性描述性研究方法。收集2013年1月至2022年12月西安交通大学第一附属医院收治的805例CP患者的临床资料;男575例,女230例;年龄为52(10~87)岁。观察指标:(1)人口学特征。(2)收治科室分布、住院及治疗情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数和百分比表示。期望频数是否符合经验分布采用拟合优度χ^(2)检验。结果(1)人口学特征。805例患者中,依据主要诊断标准和次要诊断标准确诊CP分别为435例和370例,首次就诊年龄为52(10~87)岁,其中0~10岁、11~20岁、21~30岁、31~40岁、41~50岁、51~60岁、61~70岁、71~80岁、81~90岁的男性和女性患者分别为1和0例、16和14例、45和26例、82和30例、122和39例、157和51例、119和46例、31和21例、2和3例。2013年,2014年,2015年,2016年,2017年,2018年,2019年,2020年,2021年,2022年收治的0~14岁、15~34岁、35~64岁和≥65岁患者分别为0、6、28和9例,1、21、34和10例,1、8、38和7例,0、7、52和10例,0、11、35和9例,1、15、72和23例,0、9、55和11例,2、19、58和16例,0、20、79和18例,0、25、73和22例。805例患者中,来自陕西省、甘肃省和其他地区分别为702、48和55例;汉族和回族患者分别为802和3例;已婚、未婚、离婚和丧偶患者分别为732、64、7和2例;病例资料中有血型记录为682例,其中A型、B型、AB型和O型占比分别为26.10%(178/682)、34.46%(235/682)、9.97%(68/682)和29.47%(201/682),以2022年陕西省人口血型分布特征(A型28.43%、B型30.50%、AB型9.83%和O型30.50%)为期望频数,两者比较,差异无统计学意义(χ^(2)=0.50,P>0.05)。(2)收治科室分布、住院及治疗情况。805例患者中,肝胆外科,消化内科和其他科室(老年外科、感染科、普通外科等)收治入院分别为594、121和90例,收治患者例次分别为771、121和94例次,同1例患者可能多次收治入院。805例患者住院时间为11(1~67)d,2013年,2014年,2015年,2016年,2017年,2018年,2019年,2020年,2021年,2022年肝胆外科、消化内科和其他科室收治患者的住院时间分别为16(2~48)d、11(5~19)d和24(12~35)d,18(2~63)d、10(3~29)d和14(7~30)d,9(1~35)d、11(2~16)d和10(5~33)d,10(1~55)d、9(4~16)d和16(4~27)d,9(2~38)d、10(4~20)d和11(5~27)d,12(3~46)d、11(2~26)d和13(7~27)d,11(1~33)d、9(3~23)d和14(4~17)d,11(1~67)d、7(1~23)d和16(4~27)d,10(1~35)d、8(1~32)d和14(1~29)d,9(1~42)d、12(3~17)d和11(1~22)d。805例患者中,选择外科手术治疗、胰腺体外冲击波碎石(P⁃ESWL)治疗、内镜治疗和其他治疗分别为258、117、194和236例。258例选择外科手术治疗患者共计行260例次手术,236例患者首选外科手术治疗,22例因其他治疗失败后行外科手术治疗。手术方式包括胰十二指肠切除术79例次,胰体尾切除术(联合或不联合脾脏切除、Peustow术)35例次,胰头部分切除、胰管切开取石、胰肠吻合术77例次,单纯胰管切开取石+胰肠吻合术58例次,胰腺假性囊肿内引流术4例次,胰腺坏死组织清除引流术7例次。术后58例患者发生并发症,包括出血、感染、胃瘫、胰瘘和肠漏分别为9,19,2,21和7例,患者经对症治疗后均好转出院。117例行P⁃ESWL治疗患者中,治疗次数为(1.3±0.7)次/例,共行154例次P⁃ESWL治疗,其中,行1次碎石治疗患者89例,≥2次碎石治疗患者28例。194例行内镜治疗患者中,治疗次数为(1.2±0.6)次/例,共行238例次内镜治疗,包括支架置入术103例,鼻胰管/鼻胆管引流术43例,胰管球囊扩张术7例,胰管取石术71例,十二指肠乳头肌切开术58例,其中,行1次内镜治疗患者168例,≥2次内镜治疗患者26例。患者未发生术后并发症。结论CP患者中男性占比较高,且随着年龄增长至51~60岁占比逐渐升高,患者血型分布与陕西省人口血型分布无差异性。微创治疗(胰腺体外冲击波碎石和内镜治疗)在CP治疗中的占比呈上升趋势,患者住院时间呈下降趋势。

Objective To investigate the clinical characteristics and treatment mode changes of chronic pancreatitis(CP).Methods The retrospective and descriptive study was conducted.The clinical data of 805 patients with CP who were admitted to the First Affiliated Hospital of Xi′an Jiaotong University from January 2013 to December 2022 were collected.There were 575 males and 230 females,aged 52(range,10−87)years.Observation indicators:(1)demographic characteristics;(2)distribution of admission departments,hospitalization and treatment status.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were expressed as absolute numbers and percentages.The chi‐square goodness‐of‐fit test was used for consistent between expected frequency and empirical distribution.Results(1)Demographic characteristics.Of the 805 patients,there were 435 cases and 370 cases diagnosed as CP according to the primary and secondary diagnostic criteria,respectively,and the age of initial presentation of 805 patients was 52(range,10−87)years.Among male and female patients,there was 1 and 0 case in the age group of 0−10 years,there were 16 and 14 cases in 11−20 years,45 and 26 cases in 21−30 years,82 and 30 cases in 31−40 years,122 and 39 cases in 41−50 years,157 and 51 cases in 51−60 years,119 and 46 cases in 61−70 years,31 and 21 cases in 71−80 years,2 and 3 cases in 81−90 years,respectively.Patients aged 0−14,15−34,35−64,and≥65 years were 0,6,28,and 9 for 2013,1,21,34,and 10 for 2014,1,8,38,and 7 for 2015,0,7,52,and 10 for 2016,0,11,35 and 9 for 2017,1,15,72 and 23 for 2018,0,9,55 and 11 for 2019,2,19,58 and 16 for 2020,0,20,79 and 18 for 2021,0,25,73 and 22 for 2022,respectively.Of the 805 patients,cases from Shaanxi Province,Gansu Province and other regions were 702,48 and 55,respectively.There are 802 Han and 3 Hui patients,respectively,and the married,unmarried,divorced,and widowed patients were 732,64,7,and 2,respectively.Cases with blood type information was 682,with the distribution of blood types as 26.10%(178/682)of type A,34.46%(235/682)of type B,9.97%(68/682)of type AB,29.47%(201/682)of type O,showing no significant difference compared to the distribution of blood types in population of Shaanxi Province in 2022(28.43%of type A,30.50%of type B,9.83%of type AB,and 30.50%of type O)(χ^(2)=0.50,P>0.05).(2)Distribution of departments,hospitalization,and treatment.Of the 805 patients,cases admitted to the Department of Hepatobiliary Surgery,Department of Gastroenterology and other departments(Department of Geriatric Surgery,Infectious Diseases and General Surgery)were 594,121 and 90,respectively.Cases of the number of hospitalizations in the Department of Hepatobiliary Surgery,Department of Gastroenterology and other departments were 771,121 and 94,respectively.One patient might have been admitted for multiple times.The duration of hospital of stay of 805 patients was 11(rang,1−67)days.The duration of hospital stay of patients admitted to the Department of Hepatobiliary Surgery,Department of Gastroenterology and other departments were 16(range,2−48)days,11(range,5−19)days and 24(range,12−35)days for 2013,18(range,2−63)days,10(range,3−29)days and 14(range,7−30)days for 2014,9(range,1−35)days,11(range,2−16)days and 10(range,5−33)days for 2015,10(range,1−55)days,9(range,4−16)days and 16(range,4−27)days for 2016,9(range,2−38)days,10(range,4−20)days and 11(range,5−27)days for 2017,12(range,3−46)days,11(range,2−26)days and 13(range,7−27)days for 2018,11(range,1−33)days,9(range,3−23)days and 14(range,4−17)days for 2019,11(range,1−67)days,7(range,1−23)days,and 16(range,4−27)days for 2020,10(range,1−35)days 8(range,1−32)days and,14(range,1−29)days for 2021,9(range,1−42)days,12(range,3−17)days and 11(range,1−22)days for 2022.Of the 805 patients,cases receiving treatment as surgical treatment,pancreas extracorporeal shock wave lithotripsy(P‐ESWL),endoscopic treatment and other treatments were 258,117,194 and 236,respectively.A total of 260 surgeries were performed on 258 patients receiving surgical treatment,and there were 236 cases receiving surgical treatment as the first choice,and 22 cases undergoing surgery after failed of other treatments.The surgical procedures included pancreaticoduodenectomy in 79 cases,distal pancreatectomy(with or without splenectomy,Peustow procedure)in 35 cases,partial pancreatectomy with pancreatic duct incision and stone removal and pancreaticojejunostomy in 77 cases,simple pancreatic duct incision and pancreaticojejunostomy in 58 cases,internal drainage for pancreatic pseudocysts in 4 cases,and drainage for removal of pancreatic necrotic tissue in 7 cases.There were 58 patients with postoperative complications,including 9 cases of bleeding,19 cases of infection,2 cases of gastric paresis,21 cases pancreatic fistula,and 7 cases of intestinal leakage.Cases with postoperative complications were recovered and discharged after symptomatic treatment.Of the 117 patients receiving P‐ESWL,the times of treatment per patient was 1.3±0.7,and a total of 154 times of P‐ESWL were performed.There were 89 patients receiving one time of P-ESWL,and 28 patients receiving≥2 times of P-ESWL.Of the 194 patients receiving endoscopic treatment,the times of treatment per patient was 1.2±0.6,and a total of 238 times of endoscopic treatment were performed.There were 103 cases receiving stent placement,43 cases receiving nasopancreatic/nasobiliary drainage,7 cases receiving pancreatic duct balloon dilation,71 cases receiving pancreatic stone removal,and 58 cases receiving duodenal papilla sphincterotomy.There were 168 patients receiving one time of endoscopic treatment,and 26 patients receiving≥2 times of endoscopic treatment.There was no postoperative complications reported.Conclusions The proportion of males in CP patients is relatively high,and the proportion gradually increases with age of 51−60 years.There is no significant difference in the distribution of blood types among CP patients and the population of Shaanxi Province.The proportion of minimally invasive treatment(extracorporeal shock wave lithotripsy and endoscopic therapy)in CP treatment is on the rise,and the duration of hospital stay for patients is on the decline.