MDT模式下升阶梯与跨阶梯策略治疗重症急性胰腺炎合并感染性胰腺坏死的效果对比OA
Efficacy of step-up versus step-jump strategies under multidisciplinary team for the treatment of severe acute pancreatitis complicated by infected pancreatic necrosis
目的 探讨多学科团队(MDT)模式下升阶梯(Step-up)与跨阶梯(Step-jump)策略治疗重症急性胰腺炎(SAP)合并感染性胰腺坏死(IPN)的效果对比.方法 回顾性分析2021年1月至2024年6月期间曲靖市第一人民医院收治的57例SAP合并IPN患者的临床资料,经MDT评估后分为两组,Step-up组(n=35)采用升阶梯策略治疗,Step-jump组(n=22)采用跨阶梯策略治疗.采用独立样本t检验、Mann-Whitney U和χ²检验比较两组患者手术时间,术中出血量及输血情况,术后抗生素使用时间和引流管拔除时间,住院时间,术后生命体征、实验室检查、影像学检查等指标和并发症发生情况;采用Kaplan-Meier法绘制两组患者的生存曲线.结果 57例患者中,3例拒绝手术,54例接受手术治疗,术后48～72 h生命体征均恢复稳定.Step-jump组与Step-up组患者相比,手术时间延长[145.0(104.0,186.0)min vs 97.0(65.0,130.0)min,P=0.041],术中出血量增加[130.0(80.0,180.0)mL vs 60.0(40.0,80.0)mL,P<0.001],差异有统计学意义.两组患者在术后第3天C反应蛋白(CRP)[(127.8±44.9)mg/L vs(118.3±52.9)mg/L]、术后第3天白细胞计数(WBC)[(13.1±3.1)×109/L vs(12.8±2.6)×10⁹/L]、抗生素使用时间[(12.5±2.0)d vs(13.2±4.1)d]、总体并发症发生率[12.1%(4/33)vs 14.3%(3/21)]方面比较,差异无统计学意义(均P>0.05).两组患者在总住院时间、ICU住院时间、引流管拔除时间、术后生命体征转归时间等方面比较,差异无统计学意义(P>0.05).术后影像学随访提示两组患者胰周病变均明显改善.Step-jump组和Step-up组患者术后30 d累积生存率分别为95.5%、94.3%.结论 根据MDT评估结果对SAP合并IPN患者选取升阶梯或跨阶梯策略进行治疗,均有较好的临床效果和安全性.
Objective To evaluate and compare the efficacy of the Step-up and Step-jump strategies under multidisciplinary team(MDT)in the treatment of severe acute pancreatitis(SAP)complicated by infected pancreatic necrosis(IPN).Methods A retrospective analysis was conducted on the clinical data of 57 patients with SAP and IPN admitted to Qujing First People's Hospital from January 2021 to June 2024.Based on MDT evaluation,patients were divided into the Step-up group(n=35)or the Step-jump group(n=22).Statistical comparisons between the two groups included the independent samples t-test,Mann-Whitney U test,and chi-square test for perioperative indicators including operative time,intraoperative blood loss,postoperative laboratory parameters[C-reactive protein(CRP),white blood cell count(WBC)],time of antibiotic use,time to drainage tube removal,time of hospital and ICU stay,and complication rates.Survival curves were generated using the Kaplan-Meier method.Results Among the 54 patients who underwent surgery,vital signs stabilized in all within 48～72 hours postoperation.Compared with the Step-up group,the Step-jump group had a significantly longer operation time[145.0(104.0,186.0)min vs 97.0(65.0,130.0)min,P=0.041]and greater intraoperative blood loss[130.0(80.0,180.0)mL vs 60.0(40.0,80.0)mL,P<0.001].No statistically significant differences were observed between the two groups in postoperative Day 3 CRP levels[(127.8±44.9)mg/L vs(118.3±52.9)mg/L],postoperative Day 3 WBC[(13.1±3.1)×109/L vs(12.8±2.6)×109/L],time of antibiotic use[(12.5±2.0)d vs(13.2±4.1)d],overall postoperative complication rates(12.1%vs 14.3%),time of total hospital stay and ICU stay,or time to drainage tube removal(all P>0.05).Postoperative imaging follow-up indicated significant improvement in peripancreatic lesions.The 30-day cumulative survival rates were 95.5%and 94.3%for the Step-jump and Step-up groups,respectively.Conclusion For patients with SAP and IPN,the rational selection of treatment strategy(Step-up or Step-jump)under the guidance of a MDT evaluation demonstrates favorable clinical efficacy and safety.
杨皓雯;彭雄兵;梁梅香;贺坤华;李月宏;方兴保
昆明医科大学附属曲靖医院/云南省曲靖中心医院 肝胆胰外科,云南 曲靖 655000昆明医科大学,云南 昆明 650000昆明医科大学附属曲靖医院/云南省曲靖中心医院 肝胆胰外科,云南 曲靖 655000昆明医科大学附属曲靖医院/云南省曲靖中心医院 肝胆胰外科,云南 曲靖 655000昆明医科大学附属曲靖医院/云南省曲靖中心医院 肝胆胰外科,云南 曲靖 655000昆明医科大学附属曲靖医院/云南省曲靖中心医院 肝胆胰外科,云南 曲靖 655000
医药卫生
重症急性胰腺炎感染性胰腺坏死多学科团队综合诊疗升阶梯跨阶梯
severe acute pancreatitisinfected necrotizing pancreatitismultidisciplinary teamcomprehensive diagnosis and treatmentstep-upstep-jump
《肝胆胰外科杂志》 2026 (2)
77-83,7
云南省基础研究计划昆明医科大学联合专项重点项目(202301AY070001-019)和面上项目(202401AY070001-260)昆明医科大学护理学专项基金(2025KYHLZXZK32).
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