18例闭合性胰腺损伤的CT诊断

CT diagnosis of blunt pancreatic trauma in 18 cases

目的 探讨CT扫描对胰腺损伤诊断的可信性及CT分级对胰管损伤的诊断价值。方法 由手术证实的闭合性胰腺损伤18例，回顾分析其CT资料。根据是否存在裂伤，裂伤的部位和程度等分为Ⅰ-Ⅳ级，把CT分级与手术结果相对照。结果 在15例病人中，CT正确诊断了胰腺裂伤，挫伤和创伤后假囊肿，共有2例假阴性和1例假阳性诊断；CT分级中．Ⅰ-Ⅱ级8例，胰管均完整；Ⅲ级9例，其中8例有主胰管损伤，1例胰管完整；Ⅳ级1例，病人胰管完整。结论 CT可准确地发现胰腺实质损伤．CT分级时预示胰管完整或断裂很有价值。

Objective To determine the accuracy of CT in the evaluation of blunt pancreatic trauma, and to evaluate the value of CT grading in predicling the presence or absence of ductal disruption. Methods We retrospectively reviewed CT scan of 18 patients with proven blunt pancreatic injuries. We grade these injuries On CT based on the presence or absence of pancreatic lacerations, site of lacerations, and depth of lacerations, CT grading was compared with surgical findings for glandular and ductal injuries. Results we encountered 18 patients with surgically proved blunt pancreatic injuries. CT correctly diagnosed pancreatic fractures, contusions, or posttraumatic pseudocysts in 15 of these patients. These were one false positive and two false negative diagnosis. Main pancreatic ducts were intact in all grade Ⅰ and grade Ⅱ patients（ n = 8）. Of nine grade Ⅲ injuries, eight had disruption of pancreatic duct,one had an intact ductal system. Of one grade Ⅳ injury, one had an intact ductal system. Conclusion CT is an accurate method for blunt pancreatic parenchyma, CT grading of blunt pancreatic injuries was useful in predicting ductal integrity of disruption.