摘要
目的 结合胰周膜解剖结构理论,初步探索急性坏死性胰腺炎患者炎性病灶的分区及其对疾病转归的影响.方法 回顾性分析湖南省人民医院2021年1月1日至2022年6月30日收治的197例急性坏死性胰腺炎患者的临床资料,其中男性133例,女性64例,年龄(47.2±13.3)岁.收集患者的一般资料、胰腺炎特征资料、影像资料等,结合胰周膜解剖结构理论对炎性病灶进行分区.以门诊复查及电话的方式进行随访.根据预后情况将患者分为两组:将术后并发多器官功能衰竭、严重局部并发症或死亡的患者纳入预后不良组(n=93),将未出现上述不良预后的患者纳入非预后不良组(n=104).多因素logistic回归分析预后不良的影响因素.绘制受试者工作特征(ROC)曲线评估受累区域个数对预后不良的预测效能.结果 胰周结构的炎性病灶被划分为13个分区:小网膜囊区域、胰头十二指肠区域、左肾前区域、右肾前区域、左肾后方区域、右肾后方区域、左肾周脂肪囊区域、右肾周脂肪囊区域、左侧侧腹壁区域、右侧侧腹壁区域、左侧盆腔侧壁区域、右侧盆腔侧壁区域、其他区域.预后不良组和非预后不良组患者的体质量指数、胰腺坏死面积及炎性病灶区域个数间差异具有统计学意义(均P＜0.05).多因素logistic回归分析结果显示,体质量指数高(OR=1.723,95％CI:1.457～2.038,P＜0.001)、胰腺坏死面积≥50％(OR=3.221,95％CI:1.073～9.668,P=0.037)及炎性病灶区域个数多(OR=1.388,95％CI:1.110～1.735,P=0.004)的急性坏死性胰腺炎患者,预后不良的风险高.经ROC曲线分析,炎性病灶区域个数预测急性坏死性胰腺炎患者出现不良预后的最佳截断值为5.5,曲线下面积为0.747(95％CI:0.680～0.815),灵敏度和特异度分别为0.387和0.962.结论 胰周膜解剖结构的存在使得急性坏死性胰腺炎患者炎性病灶存在相对固定的分区,且炎性病灶区域个数与不良预后相关.
Abstract
Objective To preliminarily explore the zoning of inflammatory lesions in patients with acute necrotizing pancreatitis(ANP)based on the peripancreatic membrane anatomy,and its impact on treatment outcome of ANP.Methods Clinical data of 197 patients with ANP treated at Hunan Provincial People's Hospital from January 2021 to June 2022 were retrospectively analyzed,including 133 males and 64 females,aged(47.2±13.3)years old.Basic information,characteristics of pancreatitis,and imaging data were collected.The inflammatory lesions were partitioned based on the peripancreatic membrane anatomy.Patients were followed-up via outpatient visits or telephone reviews.According to the prognosis,patients were divided into the poor-prognosis group(n=93),including patients with postoperative multi-organ fail-ure,severe local complications,and death;and the non-poor-prognosis group(n=104),including patients without these adverse outcomes.Multivariate logistic regression analysis was used to identify factors influen-cing prognosis.Receiver operating characteristic(ROC)curves were plotted to assess the predictive power of the number of involved regions for poor prognosis.Results The inflammatory lesions of pancreas were divided into 13 regions:the lesser sac,pancreatic head and duodenum,left anterior renal,right anterior renal,left posterior renal,right posterior renal,left perirenal fat sac,right perirenal fat sac,left lateral abdominal wall,right lateral abdominal wall,left pelvic wall,right pelvic wall,and other regions.Signifi-cant differences were observed between the poor-prognosis group and the non-poor-prognosis group in terms of body mass index(BMI),pancreatic necrosis area,and the number of inflammatory lesion regions(all P＜0.05).Multivariate logistic regression analysis showed that high BMI(OR=1.723,95％CI:1.457-2.038,P＜0.001),pancreatic necrosis area ≥50％(OR=3.221,95％CI:1.073-9.668,P=0.037),and a higher number of inflammatory lesion regions(OR=1.388,95％CI:1.110-1.735,P=0.004)were associated with a higher risk of poor prognosis in patients with ANP.Based on the number of inflamma-tory lesion regions,the ROC curve analysis revealed that the optimal cut-off value was 5.5 for predicting poor prognosis in patients with ANP,with an area under the curve of 0.747(95％CI:0.680-0.815)and a sen-sitivity and specificity of 0.387 and 0.962,respectively.Conclusion The peripancreatic membrane anatomy facilitates a relatively fixed partitioning of inflammatory lesions in patients with acute necrotizing pancreatitis,and the number of inflammatory lesion regions is associated with poor prognosis.
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