Prospective comparison of long term outcomes in patients with severe acute pancreatitis managed by operative and non operative measures
Prospective comparison of long term outcomes in patients with severe acute pancreatitis managed by operative and non operative measures
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DOI：
10.1016/j.pan.2015.08.006
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发表时间：
2015-09-01
期刊：
影响因子：
3.6
通讯作者：
Bhasin, Deepak Kumar
中科院分区：
文献类型：
--
作者：
Chandrasekaran, Prasanna;Gupta, Rajesh;Bhasin, Deepak Kumar
目的：本研究报告了重症急性胰腺炎后的长期功能和形态学变化，并比较了手术和非手术治疗的患者。研究了形态学变化与功能参数的关系。材料与方法：对35例急性胰腺炎发作恢复后随访1年的患者进行评价。结果：病因为酒精19例，胆结石11例，特发性5例。非手术治疗14例，手术治疗21例。非手术组平均随访18.4 +/- 8.2个月，坏死切除术组平均随访31.4 +/- 20.6个月。40%的患者有外分泌功能不全（粪脂异常），48.5%（17/35）的患者有新发糖尿病。90%患者胰腺形态改变。坏死切除组外分泌异常明显高于非手术组（57.2% vs 14.1%, p = 0.01）。行坏死切除术的患者内分泌功能障碍发生率较高（手术组61.9%，非手术组28.5%,p = 0.053）。手术组完全看不到主胰管（MPD）较多（p = 0.028），非手术组不规则胰管（MPD）较多（p = 0.021）。外分泌功能障碍在MPD完全不可见和/或MPD不完全可见的患者中更为严重（p = 0.013）。结论：与手术患者相比，非手术患者的外分泌和内分泌功能障碍明显减少。外分泌功能障碍与MPD完全不可见和/或MPD不完全可见显著相关。版权所有，IAP和EPC。由爱思唯尔印度出版，爱思唯尔印度有限公司的一个部门。版权所有。
Aim: Present study reports the long term functional and morphological changes following severe acute pancreatitis and compares patients managed by operative and non-operative methods. Association between morphological changes and functional parameters were studied.Materials and methods: 35 patients with one year of follow up after recovery from attack of acute pancreatitis were evaluated.Results: Etiology was alcohol in 19, gallstones in 11 and idiopathic in 5. Fourteen patients were managed non-operatively and 21 operatively. Patients in non-operative group had a mean follow-up of 18.4 +/- 8.2 months while patients in necrosectomy group had 31.4 +/- 20.6 months. 40% patients had exocrine insufficiency (abnormal fecal fat) while 48.5% patients (17/35) had new onset diabetes. 90% patients had morphological changes in pancreas. Exocrine abnormality was significantly higher in necrosectomy group compared to non-operative group (57.2% vs 14.1%, p = 0.01). Patients undergoing necrosectomy had higher incidence of endocrine dysfunction (61.9% in surgery and 28.5% in non-operative group (p = 0.053)}. Operative group had more number of patients with completely non-visualized main pancreatic duct (MPD) (p = 0.028) and non-operative group had significantly higher irregular MPD (p = 0.021). Exocrine dysfunction was more in patients with complete non-visualization of MPD and/or incompletely visualized MPD (p = 0.013).Conclusion: Patients managed non-operatively had significantly less exocrine and endocrine dysfunction compared to operated patients. Exocrine dysfunction was significantly associated with complete non-visualization of MPD and/or incompletely visualized MPD. Copyright (C) 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.