中国普通外科杂志2025，Vol.34Issue(9)：1902-1908,7.DOI:10.7659/j.issn.1005-6947.250123
早发广泛性气肿型胰腺炎的临床特征、病原谱及预后分析
Clinical characteristics,microbiological spectrum and outcomes of early-onset extensive emphysematous pancreatitis
摘要
Abstract
Background and Aims:Early-onset extensive emphysematous pancreatitis(EP)is a rare but highly lethal subtype of infected pancreatic necrosis(IPN),characterized by abrupt onset and rapid deterioration.This study aimed to investigate its clinical characteristics,microbiological spectrum,treatment approaches,and outcomes to provide evidence for early identification and timely intervention. Methods:A retrospective analysis was performed on 305 IPN patients treated at Xiangya Hospital,Central South University,from January 2010 to October 2023.Eight patients who developed gas accumulation involving≥50%of pancreatic or peripancreatic necrosis within two weeks of onset were defined as early-onset extensive EP.Their clinical data were compared with those of ordinary IPN patients. Results:Early-onset extensive EP accounted for 2.6%of all IPN cases.The early-onset extensive EP group had significantly higher mortality and multiple organ failure rates compared with the ordinary IPN group(75.0%vs.24.6%and 75.0%vs.34.7%,respectively;both P<0.05).A total of 15 microbial isolates were identified from early-onset extensive EP patients,predominantly Klebsiella pneumoniae(62.5%)and Escherichia coli(37.5%).The infection rate of carbapenem-resistant Enterobacteriaceae(CRE)was markedly higher in the EP group than in the ordinary IPN group(75.0%vs.31.1%,P=0.015).Most patients were treated using a step-up approach based on percutaneous catheter drainage,with no significant difference in treatment strategy between the two groups(P=0.625). Conclusion:Early-onset extensive EP represents a rare and fulminant subtype of IPN with extremely poor outcomes.Klebsiella pneumoniae and CRE are the predominant pathogens.Early radiological evaluation and timely intervention are crucial for improving prognosis in these patients.关键词
胰腺炎,急性坏死性/气肿型胰腺炎/预后Key words
Pancreatitis,Acute Necrotizing/Emphysematous Pancreatitis/Prognosis分类
临床医学引用本文复制引用
刘柏岐,黄耿文,申鼎成,宁彩虹,林嘉晏,孙泽芳,洪晓悦,朱帅,陈璐,李嘉荣..早发广泛性气肿型胰腺炎的临床特征、病原谱及预后分析[J].中国普通外科杂志,2025,34(9):1902-1908,7.基金项目
国家自然科学基金资助项目(82403227) （82403227）
湖南省自然科学基金资助项目(2023JJ30885) （2023JJ30885）
国家资助博士后研究人员计划基金资助项目(GZB20230872) （GZB20230872）
中国博士后科学基金面上资助项目和中南大学湘雅医院青年科研基金资助项目(2023Q13) （2023Q13）
中南大学研究生创新基金资助项目(2024XQLH140). （2024XQLH140）
