肝胆胰外科杂志2026，Vol.38Issue(2)：77-83,7.DOI:10.11952/j.issn.1007-1954.2026.02.001
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
Efficacy of step-up versus step-jump strategies under multidisciplinary team for the treatment of severe acute pancreatitis complicated by infected pancreatic necrosis
摘要
Abstract
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.关键词
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Key words
severe acute pancreatitis/infected necrotizing pancreatitis/multidisciplinary team/comprehensive diagnosis and treatment/step-up/step-jump分类
医药卫生引用本文复制引用
杨皓雯,彭雄兵,梁梅香,贺坤华,李月宏,方兴保..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[J].肝胆胰外科杂志,2026,38(2):77-83,7.基金项目
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) （202301AY070001-019）
昆明医科大学护理学专项基金(2025KYHLZXZK32). （2025KYHLZXZK32）
