CT 引导下胰腺穿刺早期诊断胰腺感染

Early diagnosis of pancreatic infection by CT guided needle aspiration

作者对１９９０年至１９９６年收治的１２２例重症急性胰腺炎中持续发热、白细胞增高、疑有感染的２１例患者行ＣＴ引导下细针穿刺细菌学检查，确定有无胰腺感染。在ＣＴ引导下根据病变的部位选择适当的穿刺点及进针方向。穿刺点可经前腹壁、侧腹壁或脊柱旁，并对穿刺液行细菌学检查。结果：（１）２１例共穿刺３５例次，无穿刺所致并发症。（２）证实胰腺感染１３例。细菌种类包括大肠杆菌、假单胞菌属及霉菌等；单一细菌感染７例，多种细菌感染６例。（３）胰腺感染者ＣＴ表现均为Ｄ或Ｅ级；除１例感染性假性囊肿发生于发病后３个月外，其他均发生于胰腺炎发病后４～１５天，平均１０．２天。（４）８例穿刺阴性者除１例因应激性溃疡大出血手术外，均经支持治疗治愈。提示ＣＴ引导下胰腺穿刺是早期诊断胰腺感染的可靠方法。

CT guided percutaneous needle aspirations with bacteriological sampling were performed in 21 patients suspected of pancreatic infection out of 122 patients with severe acute pancreatitis.Thirteen patients were found by smear and staining culture to have pancreatic infection, and diagnosis was confirmed by surgery.The pathogens found were E coli,pseudomonas and fungi.All pancreatic infections were in grade D or E according to the grading system of Balthazar. Seven of 8 patients with sterile aspirates were cured by nonsurgical therapy. We conclude that CT guided aspiration is a safe,accurate method for identifying infection of the pancreas at the early stage of severe acute pancreatitis.