Application of ultrasound-guided percutaneous drainage catheterization for moderately severe acute pancreatitis
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摘要:
目的 评估经皮穿刺置管引流在中度重症急性胰腺炎（MSAP）治疗中应用时机的选择对患者结局和并发症方面的影响。 方法 纳入2017年7月~2021年4月在广东省第二人民医院住院的113例MSAP患者，根据其是否行超声引导下经皮穿刺置管引流术（PCD）分为早期PCD组、晚期PCD组以及对照组，记录患者基本资料（年龄、性别、BMI、病因），比较3组临床结局（转为重症急性胰腺炎（SAP）患者人数、转外科手术患者人数、死亡患者人数）、实验室检查指标（白细胞计数、血清淀粉酶、C反应蛋白、血钙）、临床疗效时间指标（全身炎症反应时间、腹痛时间、肠鸣音恢复时间、饮食恢复时间和总住院时间）、不良事件（腹腔感染、腹腔内出血、导管堵塞）及并发症（胰腺假性囊肿、胰腺脓肿、腹腔间室综合征及多器官组织衰竭）。 结果 早期PCD组及晚期PCD组治疗成功率高于对照组，而死亡率、转为SAP患者率、外科手术率低于对照组，且早期PCD组治疗成功率高于晚期PCD组（P < 0.05）；PCD组的全身炎症反应时间、肠鸣音恢复时间和住院时间少于对照组，且早期PCD组的全身炎症反应时间及住院时间明显少于晚期PCD组（P < 0.05）；PCD组白细胞计数、血清淀粉酶、C反应蛋白和血钙的改善均优于对照组，且早期PCD组的血清淀粉酶及C反应蛋白的改善优于晚期PCD组（P < 0.05）；PCD组并发症胰腺假性囊肿、胰腺脓肿、腹腔间室综合征及多器官组织衰竭明显低于对照组（P < 0.05），且早期PCD组的腹腔间室综合征及多器官组织衰竭明显低于晚期PCD组，3组腹腔感染及出血差异无统计学意义。 结论 对MSAP患者来说，晚期等待积聚物形成包裹后再进行PCD并不会产生任何额外的好处。早期PCD治疗可有效提高MSAP患者治疗成功率，减少住院时间及并发症。 Abstract:Objective To evaluate the impact of the timing of percutaneous catheterization and drainage in the treatment of moderately severe acute pancreatitis (MSAP) on patient outcomes and complications. Methods A total of 113 patients with MSAP who were hospitalized in the Second People's Hospital of Guangdong Province from July 2017 to April 2021 were enrolled. According to whether they underwent ultrasound-guided percutaneous catheter drainage (PCD), they were divided into early PCD group, late PCD group and control group, and the basic data of the patients were recorded (age, gender, BMI, etiology), compared the three groups of clinical outcomes (number of patients converted to severe acute pancreatitis, number of patients converted to surgery, number of patients who died), laboratory test indicators (white blood cell count, serum amylase, CRP and blood calcium), clinical efficacy time indicators (systemic inflammatory response time, abdominal pain time, bowel sound recovery time, diet recovery time and total hospital stay), adverse events (abdominal infection, intra-abdominal hemorrhage, catheter blockage) and complications Symptoms (pancreatic pseudocyst, pancreatic abscess, abdominal compartment syndrome, and multiple organ tissue failure). Results The treatment success rate of the early PCD group and the late PCD group was significantly higher than that of the control group, while the mortality, the rate of severe acute pancreatitis patients, and the surgical operation rate were significantly lower than those of the control group, and the treatment success rate of the early PCD group was significantly higher than that of the late PCD group (P < 0.05); The systemic inflammatory response time, bowel sound recovery time and hospital stay in the PCD group were less than those in the control group, and the systemic inflammatory response time and hospital stay in the early PCD group were significantly less than those in the late PCD group (P < 0.05); The improvement of white blood cell count, serum amylase, CRP and blood calcium in the PCD group was better than that of the control group, and the improvement of serum amylase and CRP in the early PCD group was better than that in the late PCD group (P < 0.05); PCD The complications of pancreatic pseudocyst, pancreatic abscess, abdominal compartment syndrome and multiple organ tissue failure in the control group were significantly less than those in the control group (P < 0.05), and the early PCD group had significantly less abdominal compartment syndrome and multiple organ tissue failure In the advanced PCD group, there was no significant difference in abdominal infection and bleeding among the three groups. Conclusion For patients with MSAP, waiting for the buildup to form a package at a later stage before proceeding with PCD does not produce any additional benefits. Early PCD treatment can effectively improve the success rate of MSAP patients, reduce hospitalization time and complications. -
表 1 患者临床结局比较
Table 1. Comparison of clinical outcomes [n(%)]
组别 转外科手术率 转SAP患者率 死亡率 成功率 早期PCD（n=38） 3（7.89）a 3（7.89）a 1（2.63）a 31（81.58）ab 晚期PCD（n=35） 3（8.57）a 8（22.86） 5（14.29） 19（54.29）a 对照组（n=40） 13（32.50） 13（32.50） 8（20.00） 6（15.00） χ2/Fisher 10.898 7.132 - 35.009 P 0.004 0.028 0.045 < 0.001 aP < 0.05 vs对照组; bP < 0.05 vs晚期PCD组; SAP: 重症急性胰腺炎; PCD: 经皮穿刺置管引流. 
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表 2 患者临床疗效时间指标比较
Table 2. Comparison of clinical efficacy time indicators (d, Mean±SD)
组别 全身炎症反应时间 腹痛时间 肠鸣音恢复时间 饮食恢复时间 住院时间 早期PCD（n=38） 8.86±1.26ab 5.81±0.98 3.42±0.86a 2.25±0.56 25.82±1.52ab 晚期PCD（n=35） 9.93±1.31a 5.92±1.47 3.59±0.99a 2.43±0.66 31.08±1.66a 对照组（n=40） 10.94±0.86 6.35±1.40 5.81±0.77 2.51±0.60 38.13±2.45 F 31.516 1.857 90.194 1.906 397.060 P < 0.001 0.161 < 0.001 0.154 < 0.001 aP < 0.05 vs对照组; bP < 0.05 vs晚期PCD组.
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表 3 患者主要并发症比较
Table 3. Comparison of the main complications of the three groups [n(%)]
组别 胰腺假性囊肿 胰腺脓肿 腹腔间室综合征 多器官组织衰竭 早期PCD（n=38） 2(5.26)a 1(2.63)a 3(7.89)ab 2(5.26)ab 晚期PCD（n=35） 2(5.71)a 1(2.86)a 11(31.43)a 9(25.71)a 对照组（n=40） 12(30.00) 9(22.50) 24(60.00) 22(55.00) χ2 12.786 fisher 11.484 23.615 P 0.002 0.004 0.003 < 0.001 aP < 0.05 vs对照组; bP < 0.05 vs晚期PCD组.
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表 4 3组不良事件比较
Table 4. Comparison of adverse events in the three groups [n(%)]
组别 腹腔感染 腹腔内出血 引流管堵塞 早期PCD（n=38） 3(7.89) 3(7.89) 3(7.89) 晚期PCD（n=35） 3(8.57) 3(8.57) 4(11.42) 对照组（n=40） 4(10.00) 5(12.50) 0(0.00) χ2/Fisher - - 0.000 P 1.000 0.789 1.000
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