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,...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χ^(2)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)m L vs 60.0(40.0,80.0)m L,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)×10^(9)/L vs(12.8±2.6)×10^(9)/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。展开更多
BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehe...BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.METHODS We searched PubMed,EMBASE,Scopus,and Cochrane Library databases to identify randomized controlled trials(RCTs)that compared rectal indomethacin with a control group to prevent PEP.Duplicates were removed,and studies were included based on the established inclusion criteria.We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs.A random-effects model was applied to produce pooled risk ratios(RRs)with 95%confidence intervals(CIs).RESULTS We included a total of 30 RCTs involving 16977 patients.Compared to the control group,rectal indomethacin showed comparable rates of overall PEP(PEP;RR=0.85,95%CI:0.69-1.04,I2=79%)with no statistically significant difference of RR in mild(RR=0.92,95%CI:0.74-1.14),moderate(RR=0.78,95%CI:0.59-1.02),or severe PEP(RR=1.12,95%CI:0.75-1.67).There was also no difference in cases of adverse events(RR=0.97,95%CI:0.69-1.35),abdominal pain(RR=1.14,95%CI:0.80-1.62),bleeding(RR=1.07,95%CI:0.70-1.63),or mortality(RR=0.86,95%CI:0.56-1.33)between the two groups.Subgroup analyses were also performed.CONCLUSION Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients,though findings should be interpreted with caution due to high heterogeneity.展开更多
Acute pancreatitis(AP)is sudden inflammation of the pancreas,which can lead to multiple organ dysfunction in severe cases.Hypertriglyceridemia(HTG)is the third most common cause.In recent years,HTG-induced AP(HTG-AP)h...Acute pancreatitis(AP)is sudden inflammation of the pancreas,which can lead to multiple organ dysfunction in severe cases.Hypertriglyceridemia(HTG)is the third most common cause.In recent years,HTG-induced AP(HTG-AP)has garnered increasing attention.Compared to AP caused by other causes,HTG-AP often has a more subtle onset but is more likely to progress to a severe,critical illness that poses a serious threat to a patient’s life and health.Research suggests a potential connection between the gut microbiota and AP,which could be mediated by bacterial metabolites,immune cells,and inflammatory factors.This is supported by observations of microbial imbalance and higher intestinal permeability in patients with AP.In addition,studies have shown that HTG-induced changes in gut microbiota can worsen AP by negatively impacting the host metabolism,immune response,and function of the intestinal barrier.In this review,we summarize recent clinical and animal studies on the role and mechanism of gut microbiota in the severity of AP aggravated by HTG.The application prospects of the newly proposed microbial-host-isozyme concept are summarized,focusing on its potential for the precision diagnosis and treatment of HTG-AP through gut microbiota regulation.展开更多
文摘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χ^(2)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)m L vs 60.0(40.0,80.0)m L,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)×10^(9)/L vs(12.8±2.6)×10^(9)/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。
文摘BACKGROUND Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.AIM To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.METHODS We searched PubMed,EMBASE,Scopus,and Cochrane Library databases to identify randomized controlled trials(RCTs)that compared rectal indomethacin with a control group to prevent PEP.Duplicates were removed,and studies were included based on the established inclusion criteria.We used the Cochrane Collaboration’s tool to assess the risk of bias in the RCTs.A random-effects model was applied to produce pooled risk ratios(RRs)with 95%confidence intervals(CIs).RESULTS We included a total of 30 RCTs involving 16977 patients.Compared to the control group,rectal indomethacin showed comparable rates of overall PEP(PEP;RR=0.85,95%CI:0.69-1.04,I2=79%)with no statistically significant difference of RR in mild(RR=0.92,95%CI:0.74-1.14),moderate(RR=0.78,95%CI:0.59-1.02),or severe PEP(RR=1.12,95%CI:0.75-1.67).There was also no difference in cases of adverse events(RR=0.97,95%CI:0.69-1.35),abdominal pain(RR=1.14,95%CI:0.80-1.62),bleeding(RR=1.07,95%CI:0.70-1.63),or mortality(RR=0.86,95%CI:0.56-1.33)between the two groups.Subgroup analyses were also performed.CONCLUSION Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients,though findings should be interpreted with caution due to high heterogeneity.
基金Supported by the Innovation Foundation for Doctor Dissertation of Northwestern Polytechnical University,No.CX2023021.
文摘Acute pancreatitis(AP)is sudden inflammation of the pancreas,which can lead to multiple organ dysfunction in severe cases.Hypertriglyceridemia(HTG)is the third most common cause.In recent years,HTG-induced AP(HTG-AP)has garnered increasing attention.Compared to AP caused by other causes,HTG-AP often has a more subtle onset but is more likely to progress to a severe,critical illness that poses a serious threat to a patient’s life and health.Research suggests a potential connection between the gut microbiota and AP,which could be mediated by bacterial metabolites,immune cells,and inflammatory factors.This is supported by observations of microbial imbalance and higher intestinal permeability in patients with AP.In addition,studies have shown that HTG-induced changes in gut microbiota can worsen AP by negatively impacting the host metabolism,immune response,and function of the intestinal barrier.In this review,we summarize recent clinical and animal studies on the role and mechanism of gut microbiota in the severity of AP aggravated by HTG.The application prospects of the newly proposed microbial-host-isozyme concept are summarized,focusing on its potential for the precision diagnosis and treatment of HTG-AP through gut microbiota regulation.
