急性胰周积液和胰腺坏死对急性胰腺炎预后的影响

目的 探讨急性胰周积液和胰腺坏死对急性胰腺炎(AP)预后的影响.方法 回顾分析2003年1月至2007年12月收治的323例AP患者早期CT影像学表现,探讨急性胰周积液、胰腺坏死程度与全身炎症反应综合征(SIRS)、胰腺感染及病死率的关系.结果 发病5 d内出现SIRS并持续2 d或以上者97例(30%),12例(3.7%)在病程中、后期出现胰腺感染;病死14例(4.3%).有急性胰周积液者142例(44.0%).单个部位发生急性胰周积液者76例,其中31例发生SIRS,病死2例;多个部位急性胰周积液者66例,发生SIRS 62例,病死11例.急性胰周积液部位数量与早期SIRS发生及病死率显著相关(P＜0.01).277例(85.8%)无胰腺坏死,均未继发胰腺感染,病死4例;46例(14.2%)有不同程度胰腺坏死.胰腺坏死面积≤30%32例,胰腺感染发生率12.5%,病死率15.6%;＞30%～≤50%7例,感染发生率42.9%,病死率28.6%;＞50%7例,感染发生率为71.4%,病死率42.9%,胰腺坏死的程度与胰腺感染的发生及病死率显著相关(P＜0.05).结论 急性胰周积液和胰腺坏死对AP预后的影响不同.急性胰周积液与病程早期SIRS的发生及病死率相关;胰腺坏死与胰腺继发感染的发生及病死率有关,坏死面积越大,越容易发生胰腺感染,病死率越高.

Effect of acute peripancreatitc fluid collection and pancreatic necrosis to the prognosis of acute pancreatitis

Objective To study the Effect of acute peripancreatitc fluid collection and pancreatic necrosis to the prognosis of acute pancreatitis.Methods Retrospectively analyzing the prognostic effect of acute peripancreatitc fluid collection and pancreatic necrosis according to the early Computed-Tomograghy of 323 consecutive acute pancreatitis patients from Jan 2003 to Dec 2007,the end points are systemic inflammation response syndrome ( SIRS),pancreatic infection,and mortality.Results Within 5d after onset,97 of 323 cases (30%) presented with SIRS and lasted more than 2d,12 cases (3.7%) occurred pancreatic infection during middle or late phase,14 cases died,the mortality is 4.3%.141 of 323 cases (43.7%) who had acute peripancreatic fluid collection presented with SIRS,acute peripancreatic fluid collection correlated significantly with the occurrence of SIRS,P ＜ 0.05.227 cases (277/323,85.8%) had no pancreatic necrosis,no pancreatic infection occurred,46 cases (46/323,14.2% )had pancreatic necrosis,pancreatic necrosis correlated significantly with pancreatic infection,P ＜ 0.05.Conclusions Acute poripancreafic fluid collection and pancreatic necrosis had different prognostic effect to acute pancreatitis.Acute peripancreatic fluid collection correlated well with the occurrence of SIRS during the early phase;Pancreatic necrosis may be infected during middle or late phase of acute pancreatitis,more extent of pancreatic necrosis,more possible that pancreatic infection will occur.