超声引导下经皮穿刺置管引流对重症急性胰腺炎的疗效及应用时机的选择

Ultrasound-guided percutaneous catheter drainage for severe acute pancreatitis:efficacy and application timing

目的评估经皮穿刺置管引流术(PCD)治疗伴有急性液体积聚的重症急性胰腺炎(SAP)的临床疗效,评估PCD时机选择对SAP患者预后的影响。方法回顾性收集2017年4月至2023年4月就诊于苏州大学附属第一医院的130例伴有急性液体积聚的SAP患者资料,包括年龄、性别、病因、治疗方式、接受PCD的时间、急性液体积聚的分布范围、血淀粉酶(AMY)恢复时间、全身炎症反应综合征(SIRS)持续时间、饮食恢复时间、住院时间、患者结局(并发症、死亡)、治疗有效率等。按临床科室对患者采取的治疗方式将患者分为PCD组(72例)和保守治疗组(58例),根据PCD时机,进一步将PCD组分为早期(≤2周)PCD组(55例)和晚期(>2周)PCD组(17例)。采用χ^(2)检验比较PCD组和保守治疗组、早期PCD组和晚期PCD组患者性别、病因、积液分布范围、结局的差异;采用t检验比较PCD组和保守治疗组、早期PCD组和晚期PCD组患者年龄、住院时间的差异;采用Mann-Whitney检验比较组间AMY恢复时间、SIRS持续时间、饮食恢复时间的差异。结果PCD组血AMY恢复时间短于保守治疗组(3.00(2.25,4.00)d vs 5.00(3.75,7.00)d)、SIRS持续时间短于保守治疗组(3.00(2.00,5.00)d vs 5.00(2.75,7.25)d),并发症发生率、死亡率低于保守治疗组(11.1%vs 24.1%;4.2%vs 20.7%),治疗有效率高于保守治疗组(86.1%vs 70.7%),差异均具有统计学意义(Z=-4.489,P<0.001;Z=-2.782,P=0.005;χ^(2)=3.877,P=0.049;χ^(2)=8.592,P=0.003;χ^(2)=4.643,P=0.031)。早期PCD组患者住院时间明显短于晚期PCD组[(22.35±11.22)d vs(29.82±11.23)d],差异具有统计学意义(t=-2.395,P=0.019)。结论PCD治疗SAP是安全有效的,可改善患者预后;早期PCD更能缩短患者的住院时间。

Objective To evaluate the clinical efficacy of percutaneous catheter drainage(PCD)in the treatment of severe acute pancreatitis(SAP)with acute fluid collection and assess the impact of the choice of PCD timing on the outcome and complications of patients with SAP.Methods Data of 130 SAP patients with acute fluid collection admitted to the First Affiliated Hospital of Suzhou University from April 2017 to April 2023 were retrospectively collected,including age,sex,etiology,treatment,timing of PCD,distribution of acute fluid collection,time to blood amylase(AMY)recovery,duration of systemic inflammatory response syndrome(SIRS),time to diet recovery,hospital stay,patient outcomes(complications,death),treatment response rate,etc.The patients were divided into a PCD group(72 cases)and a conservative treatment group(58 cases)according to the treatment methods adopted.According to the timing of PCD,the PCD group was further divided into an early(≤2 weeks)PCD group(55 cases)and a late(>2 weeks)PCD group(17 cases).The Chi-square test was used to compare the difference in gender,etiology,distribution of fluid collecion,and outcome between the PCD group and conservative treatment group,and between the early PCD group and late PCD group.The t-test was used to compare the age and hospital stay between groups.The Mann-Whitney test was used to compare the difference in time to AMY recovery,SIRS duration,and time to diet recovery between groups.Results Compared with the conservative treatment group,the PCD group had significantly shorter time to recovery of blood amylase[3.00(2.25,4.00)d vs 5.00(3.75,7.00)d,Z=-4.489,P<0.001],shorter duration of SIRS[3.00(2.00,5.00)d vs 5.00(2.75,7.25)d,Z=-2.782,P=0.005],lower incidence rates of complications and mortality(11.1%vs 24.1%,χ^(2)=3.877,P=0.049;4.2%vs 20.7%,χ^(2)=8.592,P=0.003),and higher treatment efficiency(86.1%vs 70.7%,χ^(2)=4.643,P=0.031).The hospital stay was significantly shorter in the early PCD group than in the late PCD group[(22.35±11.22)d vs(29.82±11.23)d,t=-2.395,P=0.019].Conclusion PCD is safe and effective in the treatment of SAP and can improve the prognosis of patients.Early PCD is more likely to shorten patients'hospital stay and reduce complications.