Natural History of Gas Configurations and Encapsulation in Necrotic Collections During Necrotizing Pancreatitis
Natural History of Gas Configurations and Encapsulation in Necrotic Collections During Necrotizing Pancreatitis
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DOI：
10.1007/s11605-018-3792-z
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发表时间：
2018-09-01
影响因子：
3.2
通讯作者：
Bollen, Thomas L.
中科院分区：
文献类型：
--
作者：
van Grinsven, Janneke;van Brunschot, Sandra;Bollen, Thomas L.
背景 对具有感染性坏死性胰腺炎临床症状的患者进行侵入性干预的决策通常与气体构型的存在以及影像学上坏死聚集物的包裹程度有关。然而，缺乏有关坏死性胰腺炎中气体构型和包封的自然史的数据。方法对先前描述的荷兰 21 家医院的前瞻性队列（2004-2008 年）进行了事后分析。因坏死性胰腺炎住院期间进行的所有计算机断层扫描 (CT) 每周进行分类（1 至 8 次，此后）并由腹部放射科医生重新评估。 结果 总共纳入 639 名坏死性胰腺炎患者，每名患者中位数为 4 次 (IQR 2-7) CT。气体构型首次出现的发生率每周变化，但没有线性相关性：分别为 2-3-13-11-10-19-12-21-12%。总体而言，在 113/639 (18%) 名患者和 113/202 (56%) 感染性坏死患者中发现了气体结构。围壁坏死的发生率每周增加：第 1-8 周及此后分别增加 0-3-12-39-62-76-93-97-100%。前 3 周内，162/379 (43%) 例患者出现临床相关的封闭性坏死（大部分或完全包裹的坏死集合）。 结论 气体构型发生在疾病的每个阶段，并且在一半的感染性坏死性胰腺炎患者中出现。与传统观点相反，临床相关的封闭性坏死经常在前 3 周内发生。
Background Decision-making on invasive intervention in patients with clinical signs of infected necrotizing pancreatitis is often related to the presence of gas configurations and the degree of encapsulation in necrotic collections on imaging. Data on the natural history of gas configurations and encapsulation in necrotizing pancreatitis are, however, lacking.Methods A post hoc analysis was performed of a previously described prospective cohort in 21 Dutch hospitals (2004-2008). All computed tomography scans (CTs) performed during hospitalization for necrotizing pancreatitis were categorized per week (1 to 8, and thereafter) and re-assessed by an abdominal radiologist.Results A total of 639 patients with necrotizing pancreatitis were included, with median four (IQR 2-7) CTs per patient. The incidence of first onset of gas configurations varied per week without a linear correlation: 2-3-13-11-10-19-12-21-12%, respectively. Overall, gas configurations were found in 113/639 (18%) patients and in 113/202 (56%) patients with infected necrosis. The incidence of walled-off necrosis increased per week: 0-3-12-39-62-76-93-97-100% for weeks 1-8 and there-after respectively. Clinically relevant walled-off necrosis (largely or fully encapsulated necrotic collections) was seen in 162/379 (43%) patients within the first 3 weeks.Conclusions Gas configurations occur in every phase of the disease and develop in half of the patients with infected necrotizing pancreatitis. Opposed to traditional views, clinically relevant walled-off necrosis occurs frequently within the first 3 weeks.