重症急性胰腺炎肝脏体积的变化

THE CHANGE OF HEPATIC VOLUME IN SEVERE ACUTE PANCREATITIS

目的研究重症急性胰腺炎(SAP)肝脏体积的变化。方法通过肝脏CT检查总结16例SAP在发病初和发病后6个月两次CT所测肝脏体积变化,并同时观察肝脏CT值、肝脏与胸骨的关系以及血清门冬氨酸氨基转移酶、白蛋白和总胆红素水平等肝功能指标的测定。结果复查CT显示肝脏体积为(1 131±219)cm3;发病初CT显示肝脏体积为(1 593±320)cm3,两者相比差异有显著性(P<0.01);复查CT显示肝脏密度为(57±8)Hu,发病初显示肝脏密度降低,CT值为(47±10)Hu,两者相比差异有显著性(P<0.05);复查CT显示肝脏与胸骨共同出现有4.4个层面;而发病初CT显示肝脏与胸骨共同出现有8.4个层面,两者相比差异有显著性(P<0.01)。复查时血清门冬氨酸氨基转移酶和总胆红素水平测定分别为(21±4)umol/L、(28±7)u/L,发病初分别为(45±49)umol/L、(47±37)u/L,差异无显著性(P>0.05);结论SAP发病初不仅肝脏密度降低,而且肝脏体积增大明显,并向胸腔移位。肝脏体积增大,一方面提示腹腔室隔综合症不仅是积液增多或肠管扩张所致,而实质脏器因全身性炎症反应体积增大可能也是主要因素之一。

Objective To study the change of hepatic volume in severe acute pancreatitis（SAP） . Methods The change of hepatic volume measured by CT , hepatic density and relation between liver and sternum were analyzed at initial and 6 months later of 16 cases of SAP , and Aspartic Acid transaminase, albumin and total bilirubin were assayed at the same time. Results The review and initial hepatic volume was （1 131 ±219）cm^3 and （1 593 ±320）cm^3 respectively , hepatic volume for initial was enlarged significantly （ P 〈 0. 01 ） . CT attenuations for liver density of review CT was （57 ±8 ） Hu significantly higer than of initial CT which was （47 ±10）Hu （P 〈 0. 05 ） . Liver and sternum can be detected in 4. 4 common layers at review CT , other than in 8.4 common layers at imitial CT（ P 〈 0. 01 ） . Aspartic Acid transaminase and total bilirubin of review were （21 ± 4） umol/L and （28 ± 7 ） 11/L, and those of initial were（45 ±49）umol/L and（47 ±37）u/L（P 〉0.05） . Conclusion Not only hepatic density decreased,but also volume was enlarged obviously and hepatic shifted to thoracic cavity at initial in SAP. Enlarged liver may be one of causes of abdominal compart- ment syndrome.