RESUMEN

ObjectiveTo investigate the influencing factors for chronic pancreatitis （CP） complicated by pancreatogenic portal hypertension （PPH）， and to establish a predictive model. MethodsA retrospective analysis was performed for the clinical data of 99 patients with CP complicated by PPH who were hospitalized in The First Affiliated Hospital of Kunming Medical University， Chuxiong Yi Autonomous Prefecture People’s Hospital， Wenshan People’s Hospital， and Puer People’s Hospital from January 2017 to December 2022， and these patients were enrolled as PPH group. The incidence density sampling method was used to select 198 CP patients from databases as control group. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The Least Absolute Shrinkage and Selection Operator （LASSO） regression model was used to identify the potential predictive factors for CP complicated by PPH， and the predictive factors obtained were included in the multivariate Logistic regression analysis to obtain independent risk factors， which were used to establish a nomogram prediction model. The receiver operating characteristic （ROC） curve， the calibration curve， and the Hosmer-Lemeshow goodness-of-fit test were used to perform internal validation of the model， and the clinical decision curve was used to assess the clinical practicability of the model. ResultsThere were significant differences between the two groups in sex， history of recurrent acute pancreatitis attacks， acute exacerbation of CP， bile duct stones， peripancreatic fluid accumulation， pseudocysts， pulmonary infection， elevated C-reactive protein （CRP）， elevated procalcitonin， fibrinogen （FIB）， neutrophil-lymphocyte ratio （NLR）， gamma-glutamyl transpeptidase， total bilirubin， direct bilirubin， low-density lipoprotein （LDL）， serum amylase， D-dimer， and serum albumin （all P<0.05）. The predictive variables obtained by the LASSO regression analysis included sex， recurrent acute pancreatitis attacks， bile duct stones， peripancreatic fluid accumulation， pulmonary infection， pseudocysts， CRP， NLR， FIB， and LDL. The multivariate Logistic regression analysis showed that sex （odds ratio ［OR］=2.716， P<0.05）， recurrent acute pancreatitis attacks （OR=2.138， P<0.05）， peripancreatic fluid accumulation （OR=2.297， P<0.05）， pseudocysts （OR=2.805， P<0.05）， and FIB （OR=1.313， P<0.05） were independent risk factors for CP complicated by PPH. The above factors were fitted into the model， and the Bootstrap internal validation showed that the nomogram model had an area under the ROC curve of 0.787 （95% confidence interval： 0.730 — 0.844）， and the calibration curve was close to the reference curve. The Hosmer-Lemeshow goodness-of-fit test showed that the model had a good degree of fitting （χ2=7.469， P=0.487）. The clinical decision curve analysis showed that the prediction model had good clinical practicability. ConclusionMale sex， recurrent acute pancreatitis attacks， peripancreatic fluid accumulation， pseudocysts， and FIB are independent risk factors for CP complicated by PPH， and the nomogram model established has good discriminatory ability， calibration， and clinical practicability.

RESUMEN

Objective:To explore the clinical characteristics and to analyze the risk factors of recurrent acute pancreatitis (RAP).Methods:The clinical data of 3 022 patients with AP from AP database of the Affiliated Hospital of Southwest Medical University between January 2013 and December 2019 were retrospectively analyzed. According to with or without AP relapse and RAP diagnostic criteria, the patients were divided into initial group ( n=2 187) and recurrent group ( n=835). General characteristics, clinical data, and prognostic indicators were compared between the two groups. Multivariate logistic regression analysis was used to explore the risk factors of RAP. Results:The proportion of men, previous biliary disease, hyperlipidemia, diabetes mellitus and previous gallbladder or biliary surgery in recurrent group were significantly higher, while the mean age was significantly lower than that of the initial group. The main causes in the initial group successively were biliary disorders, hyperlipidemia and alcohol, while in the recurrent group were hyperlipidemia, biliary disorders and alcohol. The etiology of hyperlipidemia was significantly higher in the recurrent group than in initial group. The incidence of MAP and regional portal hypertension was significantly higher in the recurrent group, while the incidence of SAP and acute respiratory distress syndrome were significantly lower than those in the initial group, and all the differences were statistically significant(All P value <0.001). The results of the correlation analysis showed that there was no correlation between the severity of RAP and the number of recurrence, and the risk of SAP in RAP did not decrease with the increasing number of recurrence. The results of the multivariate logistic regression analysis showed that previous biliary disorders ( OR=1.303, 95% CI 1.032-1.645, P=0.026), previous history of hyperlipidemia ( OR=2.631, 95% CI 1.580-4.379, P<0.001), and the etiology of hyperlipidemia ( OR=1.773, 95% CI 1.465-2.145, P<0.001) were independent risk factors for RAP. Conclusions:RAP may often occur in middle-aged men and hyperlipidemia is the main cause of RAP, previous history of hyperlipidemia and biliary disease are risk factors for RAP.

RESUMEN

Solid pseudopapillary tumor of the pancreas (SPTP) is a rare neoplasm with a low incidence and low rate of malignancy. We herein report a rare case of SPTP concurrent with regional portal hypertension (RPH) that was successfully treated by distal pancreatectomy and splenectomy. A 22-year-old woman presented with a left upper abdominal apophysis and normal liver function. She was diagnosed with an SPTP and RPH by abdominal ultrasound and computed tomography, and she subsequently underwent distal pancreatectomy and splenectomy. Noticeably, varicose vein plexus with wide range appeared on the upper edge of the pancreatic body and posterior gastric wall of the patient. Therefore, we created a path to avoid touching the varicose veins and took advantage of the endoscopic linear stapler to staple the veins. We herein report our surgical experience on SPTP assisted with the endoscopic linear stapler, which will be very realistic for the management of this rare clinical entity.

Asunto(s)

RESUMEN

Objective To investigate the features of computed tomography (CT) and magnetic resonance imaging (MRI) of regional portal hypertension (RPH).Methods The retrospective cohort study was conducted.The clinicopathological data of 31 patients with PHR in the RPH group and 31 patients with liver cirrhotic portal hypertension (CPH) in the CPH group who were admitted to the Affiliated Hospital of Inner Mongolia Medical University between February 2014 and February 2018 were collected.Etiologies of patients in the RPH group included 21 of chronic pancreatitis complicated with pancreatic pseudocyst,5 of carcinoma of pancreatic body and tail,1 of solid pseudopapillary tumor of the pancreas,1 of pancreatic serotls cystoadenoma,1 of gastric stromal tumor,1 of retroperitoneal metastatic tumor and 1 of left renal carcinoma.Etiologies of patients in the CPH group included 27 of liver cirrhosis after viral hepatitis type B (4 complicated with liver metastasis),3 of alcoholic cirrhosis and 1 of cholestatic cirrhosis.All the patients underwent CT and MRI examinations.Patients in the RPH group were mainly treated the primary diseases and patients in the CPH group were decreased portal vein pressure.Observation indicators:(1) imaging features of patients in the two groups;(2) treatment and follow-up situations.Follow-up using outpatient examination and telephone interview were performed to detect management of portal hypertension after treatment up to February 2018.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed by the t test.Measurement data were represented as M (range) and comparison between groups was analyzed by the Mann-Whitney rank sum test.Count data were compared with chi-square test.Results (1) Imaging features of patients in the two groups:of 31 patients in the RPH group,12 underwent CT examination,2 underwent MRI examination,and 17 underwent CT combine with MRI examination.Of 31 patients in the CPH group,12 underwent CT examination and 19 underwent CT combined with MRI examination.The number of patients with varices in the gastric fundus,the number of patients with combined esophageal varices,the number of perigastric varices,diameter of main portal vein,diameter of splenic vein,liver volume,splenic volume,hepatosplenic volume ratio were 11,1,49,(13.9±2.9) mm,(12.0±2.8) mm,1 383 cm3 (range,1 005-1 637 cm3),271 cm3(range,199-311 cm3) and 5.5±2.0 in the RHP group and 24,21,33,(16.3±1.7)mm,(10.5±3.2)mm,1 087 cm3(range,916-1 536 cm3),603 cm3(range,415-869 cm3) and 2.2±0.9 in the CHP group,with statistically significant differences in the number of patients with varices in the gastric fundus,the number of patients with combined esophageal varices,the number of perigastric varices,diameter of main portal vein,splenic volume,hepatosplenic volume ratio between the two groups (x2=11.088,28.182,8.940,t=4.430,Z=6.205,t=8.544,P＜0.05) and with no statistically significant differences in the diameter of splenic vein and liver volume between the two groups (t=1.974,Z=1.162,P＜0.05).Of 31 patients in the RPH group,2 with pancreatic pseudocyst were misdiagnosed as pancreatic cancer and 29 were diagnosed accurately by imaging examinations.Of 31 patients in the CPH group,3 with liver metastasis were undetected by CT examination and the other 28 were diagnosed accurately by imaging examinations.Splenic vein occlusion,severe splenic vein stenosis,moderate splenic vein stenosis and mild splenic vein stenosis were detected in 2,17,10 and 2 of 31 patients in the RHP group.All the 31 patients in the CHP group mainly had dilation in splenic veins,with no clear stenosis.(2) Treatment and follow-up situations:patients in the two groups were followed up for 6-48 months,with a median time of 21 months.Of 21 patients with chronic pancreatitis complicated with pancreatic pseudocyst in the RPH group,7 underwent pancreatic pseudocyst puncture and drainage,6 of them had poor control on portal hypertension and 1 had moderate control;4 underwent pancreaticoenteric drainage,1 of them underwent pancreaticojejunostomy 4 years later and 3 of them had good control on portal hypertension;3 undergoing splenectomy combined with perigastrectomy had good control on portal hypertension;7 undergoing conservative treatment had good control on portal hypertension.Of 5 patients with carcinoma of pancreatic body and tail in the RHP group,2 undergoing distal pancreatectomy combined with splenectomy had good control on portal hypertension and 3 undergoing non-operative combined therapy died of primary disease one year later.One,1 and 1 patient with solid pseudopapillary tumor of the pancreas,pancreatic serotls cystoadenoma and gastric stromal tumor respectively in the RHP group underwent relative surgical treatments and had good control on portal hypertension.One and 1 patient with retroperitoneal metastatic tumor and left renal carcinoma respectively in the RHP group underwent non-operative combined therapy and had good control on portal hypertension.All the 31 patients in the CHP group were mainly treated with protection of liver function,8 of them were encounted with medusa head,7 with upper gastrointestinal rehemorrhage within one year,5 with subcutaneous varicose vein of abdominal wall,3 with continuing increase of spleen volume and 8 had good control on portal hypertension.Conclusions RHP are existed in pancreatic,splenic or peritoneal diseases,especially the pancreatic primary diseases.The main imaging features of RHP include isolated gastric varices,perigastric varices and splenic vein occlusion without normal main portal vein and liver function.Surgical resection of primary tumor and reasonable splenectomy are effective therapy.

RESUMEN

Regional portal hypertension is a rare cause of upper gastrointestinal bleeding. We reported an extremely rare case in which regional portal hypertension was associated with both the splenic arteriovenous fistula and chronic pancreatitis. In June 2010, our patient, a 41-year-old man, was admitted to a local hospital due to a sudden melena and dizziness without haematemesis and jaundice. The splenic arteriovenous fistula in this patient was successfully occluded through transcatheter arterial embolization. At the 12-mo follow-up, our patient was in good condition.

Asunto(s)