Objective: To investigate the clinical characteristics of colon complications in patients with necrotizing pancreatitis(NP). Methods: The clinical data of 403 patients with NP admitted to the Department of General Surgery,Xuanwu Hospital, Capital Medical University from January 2014 to December 2021 were retrospectively analyzed. There were 273 males and 130 females,aged (49.4±15.4) years(range: 18 to 90 years). Among them,there were 199 cases of biliary pancreatitis,110 cases of hyperlipidemic pancreatitis,and 94 cases of pancreatitis caused by other causes. A multidisciplinary diagnosis and treatment model was used to diagnose and treat patients. Depending on whether the patients had colon complications,they were divided into colon complications group and noncolon complications group. Patients with colon complications were treated with anti-infection therapy,parental nutritional support,keeping the drainage tube unobstructed,and terminal ileostomy. The clinical results of the two groups were compared and analyzed using a 1∶1 propensity score match(PSM) method. The t test,χ2 test, or rank-sum test was used to analyze data between groups,respectively. Results: The incidence of colon complications was 13.2%(53/403),including 15 cases of colon obstruction,23 cases of colon fistula,and 21 cases of colon hemorrhage. After PSM,the baseline and clinical characteristics at admission of the two groups of patients were comparable (all P>0.05). In terms of clinical outcome,compared to patients with NP without colon complications,the number of patients with colon complications who received minimally invasive intervention(88.7%(47/53) vs. 69.8%(37/53),χ2=5.736,P=0.030),the number of minimally invasive interventions (M(IQR))(2(2) vs. 1(1), Z=4.638,P=0.034),the number of patients with multiple organ failure(45.3%(24/53) vs. 32.1%(17/53),χ2=4.826,P=0.041),and the number of extrapancreatic infections(79.2%(42/53) vs. 60.4%(32/53),χ2=4.476,P=0.034) increased significantly. The time required for enteral nutrition support(8(30)days vs. 2(10) days, Z=-3.048, P=0.002), parental nutritional support(32(37)days vs. 17(19)days, Z=-2.592, P=0.009),the length of stay in the ICU(24(51)days vs. 18(31)days, Z=-2.268, P=0.002),and the total length of stay (43(52)days vs. 30(40)days, Z=-2.589, P=0.013) were also significantly prolonged. However,mortality rates in the two groups were similar(37.7%(20/53) vs. 34.0%(18/53),χ2=0.164,P=0.840). Conclusions: Colonic complications in NP patients are not rare,which can lead to prolonged hospitalization and increased surgical intervention. Active surgical intervention can help improve the prognosis of these patients.
目的： 探讨坏死性胰腺炎患者发生结肠并发症后的临床特征。 方法： 回顾性分析2014年1月至2021年12月就诊于首都医科大学宣武医院普通外科的403例坏死性胰腺炎患者的临床资料。男性273例，女性130例，年龄（49.4±15.4）岁（范围：18~90岁）。其中胆源性胰腺炎199例，高脂血症性胰腺炎110例，其他原因引起的胰腺炎94例。采用多学科诊疗模式对坏死性胰腺炎患者进行诊治。根据患者有无结肠并发症将患者分为结肠并发症组和无结肠并发症组。结肠并发症组患者采取抗感染、肠外营养支持、保持引流管通畅、末端回肠造瘘等方式进行治疗。采用1∶1倾向性评分匹配（PSM）法对两组患者的临床资料进行匹配。分别通过t检验、χ2检验或Fisher确切概率法对组间数据进行分析。 结果： 403例坏死性胰腺炎患者中，出现结肠并发症53例，包括结肠漏23例，结肠梗阻15例，结肠出血21例。PSM后，两组各有53例患者。两组患者的基线数据和入院时临床特征具有可比性（P值均>0.05）；临床转归方面，与无结肠并发症组相比，结肠并发症组患者接受微创干预的比例［88.7%（47/53）比69.8%（37/53），χ2=5.736，P=0.030］、微创干预次数［M（IQR）］［2（2）次 比1（1）次，Z=4.638，P=0.034］、出现多器官功能衰竭比例［45.3%（24/53）比32.1%（17/53），χ2=4.826，P=0.041］及胰外感染比例［79.2%（42/53）比60.4%（32/53），χ2=4.476，P=0.034］明显增多，需要肠内营养支持时间［8（30）d比2（10）d，Z=-3.048，P=0.002］、肠外营养支持时间［32（37）d比17（19）d，Z=-2.592，P=0.009］、ICU住院时间［24（51）d比18（31）d，Z=-2.268，P=0.002］和总住院时间［43（52）d比30（40）d，Z=-2.589，P=0.013］明显延长。两组患者病死率相近［37.7%（20/53）比34.0%（18/53），χ2=0.164，P=0.840］。 结论： 坏死性胰腺炎患者出现结肠并发症可导致坏死性胰腺炎患者住院时间延长和外科干预次数增多，积极的外科干预有助于改善此类患者的预后。.