论文部分内容阅读
目的:分析急性坏死性胰腺炎患者术后发生结肠瘘的危险因素。方法:选取我院2009年1月至2012年12月收治的急性坏死性胰腺炎并行坏死组织清除术的患者,根据术后是否发生结肠瘘将患者分为肠瘘组和非肠瘘组,分析可能影响术后发生结肠瘘的危险因素。结果:237例患者分为肠瘘组27例(13%),非肠瘘组210例。单因素分析显示影响急性坏死性胰腺炎患者术后发生结肠瘘的因素为高龄、高体重指数、术前发生单器官衰竭、术前低蛋白血症和CT影像学表现气泡征(P<0.05)。多因素分析显示影响急性坏死性胰腺炎患者术后发生结肠瘘的因素为术前发生单器官衰竭(OR=6.289,95%CI 1.652~12.908,P=0.007)、术前低蛋白血症(OR=1.138,95%CI 1.018~1.361,P=0.023)和CT影像学表现气泡征(OR=1.126,95%CI 1.025~1.272,P=0.044)。结论:术前CT气泡征、低蛋白血症、任一时间段的器官衰竭是术后发生结肠瘘的危险因素,及时的影像学资料预测及术前合理的内科管理可防止急性坏死性胰腺炎患者术后结肠瘘的发生。
Objective: To analyze the risk factors of postoperative colonic fistula in patients with acute necrotizing pancreatitis. Methods: We selected patients with acute necrotizing pancreatitis and necrotic tissue debridement who were treated in our hospital from January 2009 to December 2012. The patients were divided into intestinal fistula group and non-intestinal fistula group according to whether postoperative colon fistula occurred or not. May affect the risk factors for postoperative colonic fistula. Results: 237 patients were divided into intestinal fistula group 27 cases (13%), non-intestinal fistula group 210 cases. Univariate analysis showed that the incidence of colonic fistula in patients with acute necrotizing pancreatitis was high age, high body mass index, preoperative single organ failure, preoperative hypoproteinemia and CT imaging findings bubble sign (P <0.05) . Multivariate analysis showed that the incidence of colonic fistula in patients with acute necrotizing pancreatitis was single organ failure (OR = 6.289, 95% CI 1.652-12.908, P = 0.007), preoperative hypoproteinemia = 1.138, 95% CI 1.018 ~ 1.361, P = 0.023), and CT findings of gas bubbles (OR = 1.126,95% CI 1.025-1.272, P = 0.044). Conclusions: Preoperative CT blister syndrome, hypoproteinemia, and organ failure at any time are the risk factors for postoperative colonic fistula. Timely imaging data prediction and preoperative rational medical management can prevent acute necrotizing pancreatitis Postoperative colon fistula occurred.