The continuum of complications in survivors of necrotizing pancreatitis.
The continuum of complications in survivors of necrotizing pancreatitis.
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DOI：
10.1016/j.surg.2020.07.004
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发表时间：
2020-12
期刊：
影响因子：
3.8
通讯作者：
Zyromski NJ
中科院分区：
文献类型：
--
作者：
Maatman TK;Roch AM;Ceppa EP;Easler JJ;Gromski MA;House MG;Nakeeb A;Schmidt CM;Sherman S;Zyromski NJ
坏死性胰腺炎幸存者出现感染坏死以外的并发症，通常需要侵入性干预。值得注意的是，很少有数据记录这些急性坏死性胰腺炎消退后的晚期并发症。我们试图确定坏死性胰腺炎后并发症的类型和发生率。对2005年至2017年在一家三级护理医院的单一机构数据库中捕获的647名坏死性胰腺炎患者进行了一项观察性研究。对可归因于坏死性胰腺炎的新诊断疾病进行了回顾性回顾和分析。排除标准包括：疾病缓解前死亡(n=57，9%)和失访患者(n=12，2%)。共对578例坏死性胰腺炎患者进行了中位时间46个月(8个月至15年)的随访。在489例(85%)患者中，出现了一种或更多并发症，包括症状性胰管脱通综合征(285/578，49%)、内脏静脉血栓(257/572，45%)、新内分泌功能不全(195/549，35%)、新外分泌功能不全(108/571，19%)、症状性慢性胰腺炎(93/571，16%)、切口性疝气(89/420，21%)、胆道狭窄(90/576，16%)、慢性疼痛(44/575，8%)、胃肠瘘(44/578，8%)、胰管狭窄(30/578，5%)、十二指肠狭窄(28/578，5%)。在随访期内，共有340名(59%)患者在坏死性胰腺炎消退后需要介入治疗。230例(40%)患者需要有创性胰胆管介入治疗。晚期并发症在坏死性胰腺炎幸存者中很常见。在急性疾病过程得到解决后，各种各样的问题就会显现出来，往往需要侵入性干预。坏死性胰腺炎患者应由有经验的临床医生进行终生随访。
Necrotizing pancreatitis survivors develop complications beyond infected necrosis that often require invasive intervention. Remarkably few data have cataloged these late complications after acute necrotizing pancreatitis resolution. We sought to identify the types and incidence of complications after necrotizing pancreatitis. An observational study was performed evaluating 647 patients with necrotizing pancreatitis captured in a single-institution database between 2005 and 2017 at a tertiary care hospital. Retrospective review and analysis of newly diagnosed conditions attributable to necrotizing pancreatitis was performed. Exclusion criteria included the following: death before disease resolution (n = 57, 9%) and patients lost to follow-up (n = 12, 2%). A total of 578 patients were followed for a median of 46 months (range, 8 months to 15 y) after necrotizing pancreatitis. In 489 (85%) patients 1 or more complications developed and included symptomatic disconnected pancreatic duct syndrome (285 of 578, 49%), splanchnic vein thrombosis (257 of 572, 45%), new endocrine insufficiency (195 of 549, 35%), new exocrine insufficiency (108 of 571, 19%), symptomatic chronic pancreatitis (93 of 571, 16%), incisional hernia (89 of 420, 21%), biliary stricture (90 of 576, 16%), chronic pain (44 of 575, 8%), gastrointestinal fistula (44 of 578, 8%), pancreatic duct stricture (30 of 578, 5%), and duodenal stricture (28 of 578, 5%). During the follow-up period, a total of 340 (59%) patients required an invasive intervention after necrotizing pancreatitis resolution. Invasive pancreatobiliary intervention was required in 230 (40%) patients. Late complications are common in necrotizing pancreatitis survivors. A broad variety of problems manifest themselves after resolution of the acute disease process and often require invasive intervention. Necrotizing pancreatitis patients should be followed lifelong by experienced clinicians.
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