急性胰腺炎左上腹积液与脾脏并发症相关性的影像学研究

The association between the fluid collections of left upper abdomen and splenic complications in acute pancreatitis by radiological study

目的基于影像学分析急性胰腺炎(AP)伴左上腹不同部位积液与脾脏相关并发症发生风险之间的关系。方法采集2018年1月至2022年12月西部战区总医院收治的236例AP患者的CT或MRI图像。采用优势比的χ^(2)检验分析影像图像中胰尾胰瘘(PFIT)、网膜囊假性囊肿(PILS)和左肾前筋膜内积液与各类脾脏并发症之间的相关性。采用两独立样本t检验分析前述3种左上腹积液患者与其对照组的急性胰腺炎严重程度床边评分(BISAP)评分。结果PFIT与脾门假性囊肿(OR=2.714,P<0.001)、脾梗塞(OR=9.970,P<0.001)、脾包膜下积液(OR=10.903,P<0.001)、脾破裂(OR=20.576,P<0.001)和左侧区域性门静脉高压(SPH)(OR=6.524,P<0.001)之间均呈正相关。而PILS与脾门假性囊肿(OR=0.471,P=0.01)、脾梗塞(OR=0.316,P=0.010)、脾包膜下积液(OR=0.512,P=0.032)、脾破裂(OR=0.092,P<0.001)和SPH(OR=0.492,P=0.009)之间均呈负相关。PILS患者与其对照组的BISAP评分是0.511±0.723和1.828±1.050(P<0.001)。结论PFIT和PILS分别是脾脏并发症的重要风险因子和保护因子;AP合并PILS者,其进展为重症急性胰腺炎(SAP)的风险会有所降低。

Objective The correlations between fluid collections at different areas of left upper abdomen and the risk factors of developing to splenic complications in acute pancreatitis(AP) were analyzed on the basis of radiology.Methods CT or MRI images of 236 patients with the AP admitted to the general hospital of western theater command from January 2018 to December 2022 were collected.The correlations of pancreatic fistula in the tail(PFIT),pseudocysts in lesser sac(PILS) and fluid collections in left anterior renal fascia with different kinds of splenic complications were evaluated with the chi-squared test using odds ratio(OR) on radiological images.BISAP scores between patients with three aforementioned fluid collections of left upper abdomen and their controls were compared by two independent sample t-tests,respectively.Results The PFIT correlated postively with the pseudocyst of splenic hilum(OR=2.714,P<0.001),splenic infarction(OR=9.970,P<0.001),subcapsular fluid collections(OR=10.903,P<0.001),splenic rupture(OR=20.576,P<0.001) and the sinistral portal hypertation(SPH)(OR=6.524,P<0.001),respectively.In contrast,the PILS correlatednegatively withthe pseudocyst of splenic hilum(OR=0.471,P=0.01),splenic infarction(OR=0.316,P=0.010),subcapsular fluid collections(OR=0.512,P=0.032),splenic rupture(OR=0.092,P<0.001) and the SPH(OR=0.492,P=0.009),respectively.The BISAP score in patients with the PILS and its controls was 0.511±0.723 vs 1.828±1.050(P<0.001).Conclusion The presence of a PFIT and PILS were important risk factor for a protective factor against splenic complications,respectively.Moreover,the presence of the PILS may decrease the risk of AP patients to develop to the severe acute pancreatitis(SAP).