目的:内镜超声(EUS)引导下的内镜下坏死切除术是一种有效的微创治疗壁下胰腺坏死(WON)的方法。这项研究调查了影响EUS引导的WON坏死切除术时间间隔的因素。
方法:对近5年在重庆医科大学附属第一医院内镜中心行EUS引导下的坏死切除术患者进行回顾性分析。数据包括一般信息,病因学,血液生化指标,身体体征,CT严重程度等级,location,尺寸,固体坏死率,支架的类型和数量,收集即刻坏死切除术,探讨这些因素与内镜下坏死切除术间隔之间的关系。
结果:共纳入51例WON患者。内镜清创间期与以下指标之间无显著相关性,包括患者的一般信息,胰腺炎的病因,血液生化指标(白细胞计数,中性粒细胞百分比,C反应蛋白),术前发热,和WON\的位置和大小,支架的类型和数量,以及是否立即行坏死切除术。然而,清创间期与改良CT严重程度指数(MCTSI)之间存在显著差异(p<0.001),干预前WON的固体坏死率(p<0.001),术后发热(p=0.038),C反应蛋白升高(p=0.012)和再次干预前发热(p=0.024)。
结论:EUS测量的固体坏死率,MCTSI,术后发热,C反应蛋白增加,再次干预前的发热会影响WON患者EUS引导下内镜下坏死切除术的时间间隔。这五个指标可能在预测和管理内窥镜坏死切除术间隔方面非常有效。
OBJECTIVE: Endoscopic ultrasound (EUS)-guided endoscopic necrosectomy is an effective and minimally invasive treatment for walled-off pancreatic necrosis (WON). This
study investigated the factors affecting the time interval of EUS-guided WON necrosectomy.
METHODS: Patients who received EUS-guided necrosectomy in the Endoscopy Center of the First Affiliated Hospital of Chongqing Medical University in the past 5 years were retrospectively analyzed. Data including general information, etiology, blood biochemical indexes, physical signs, CT severity grade, location, size, solid necrotic ratio, type and number of stents, and immediate necrosectomy were collected to explore the relationships between these factors and the interval of endoscopic necrosectomy.
RESULTS: A total of 51 WON patients were included. No significant correlation has been noted between the endoscopic debridement interval and the following indexes, including the patients\' general information, the etiology of pancreatitis, blood biochemical indexes (leukocyte count, neutrophil percentage, C-reactive protein), preoperative fever, and WON\'s location and size, type and number of stents, and whether immediate necrosectomy. However, there were significant differences between the debridement interval and the modified CT Severity Index (MCTSI) (p < 0.001), the solid necrotic ratio of WON (p < 0.001) before the intervention, postoperative fever (p = 0.038), C-reactive protein increasing (p = 0.012) and fever before reintervention (p = 0.024).
CONCLUSIONS: The EUS-measured solid necrotic ratio, the MCTSI, postoperative fever, C-reactive protein increase, and fever before reintervention in patients affect the time interval of EUS-guided endoscopic necrosectomy in WON patients. These five indicators may be promisingly effective in predicting and managing endoscopic necrosectomy intervals.