Analysis Of Risk Factors And Efficacy Observation For Severe Acute Pancreatitis Complicated With Alimentary Tract Fistula

Objective: To explore the risk factors of severe acute pancreatitis(SAP)complicated with alimentary tract fistula(ATF)and observe the outcome of curative effect,in order to guide clinical practice better.Methods: A retrospective controlled study was conducted to collect clinical data of 361 SAP patients admitted to our hospital from January2013 to December 2018 in accordance with the inclusion and exclusion criteria.Including clinical general data,laboratory test results,imaging test results and other data.According to whether SAP patients had alimentary tract fistula,they were divided into alimentary tract fistula group and non-alimentary tract fistula group,and the related factors of alimentary tract fistula were analyzed.Related factors include gender,age,body mass index,with hypertension,with diabetes,with hyperlipidemia,admission albumin levels,number of percutaneous puncture and drainage,timing of surgical debridement,surgical debridement method,number of surgical debridement,number of postoperative drainage tubes,CT showed air bubble signs,MCTSI,pancreatic infection,extrapancreatic inflammation invasion.the statistical software was used to perform a univariate analysis of each relevant factor.The statistically significant(P<0.05)indicators in the univariate analysis were further analyzed by a multivariate logistic regression model,and the risk factors of SAP complicated with alimentary tract fistula were obtained.Results: A total of 361 SAP patients were included in this study.Including 16 cases in the alimentary tract fistula group and 345 cases in the non-alimentary tract fistula group.the incidence of gastrointestinal fistula was 4.3%.Based on a univariate analysis of factors related to the alimentary tract fistula group and the non-alimentary tract fistula group,There were statistical differences between admission albumin level,CT showed bubble signs,MCTSI,pancreatic infection,extrapancreatic inflammation,percutaneous puncture and drainage times,and the timing of surgical debridement and SAP complicated with alimentary tract fistula(p<0.05).Multivariate analysis showed that there was a statistical difference between pancreatic infection and SAP complicated with alimentary tract fistula(p <0.05).Among the 16 cases of alimentary tract fistula,there were 8 cases of simple colon fistula(50%);4 cases of simple duodenal fistula(25%);and 2 cases of simple gastrostomy(12.5%);1 case with duodenal fistula and colonic fistula(6.25%);1 case with gastric fistula and duodenal fistula(6.25%).Nine of the 16 alimentary tract fistula included colonic fistulas,the highest proportion.Six of the 16 patients with alimentary tract fistula died during hospitalization and follow-up due to multiple organ failure or abdominal bleeding,and 28 of the 345 patients with non-alimentary tract fistula group died duringhospitalization and follow-up due to severe SAP-related complications.The mortality of the alimentary tract fistula group was37.5%,and the mortality of the non-alimentary tract fistula group was8.1%.Statistical analysis showed that P<0.05,that showed statistical difference.The average length of stay in the alimentary tract fistula group was 77.5 days,and the average length of stay in the non-alimentary tract fistula group was 20.9 days.Statistical analysis showed that P<0.05,that showed statistical difference.Conclusions:1.Admission albumin level,pancreatic infection,extrapancreatic inflammation invasion,MCTSI,CT showed air bubble sign,number of percutaneous puncture and drainage,and timing of surgical debridement may be risk factors for SAP complicated with alimentary tract fistula.pancreatic infection is an independent risk factor for SAP complicated with alimentary tract fistula.2.Patients with SAP recommend debridement surgery at least 4 weeks after onset.debridement surgery 6 weeks after onset has a lower incidence of alimentary tract fistula.3.Colonic fistula is the most common in SAP patients with alimentary tract fistula.4.The mortality of SAP patients with alimentary tract fistula is higher than that of SAP patients without alimentary tract fistula,and the hospitalization time of patients with alimentary tract fistula is significantly longer.