CT评价急性重症胰腺炎预后的价值

CT evaluation for prognosis of severe acute pancreatitis

目的:探讨CT对急性重症胰腺炎病变范围的诊断价值及其与预后的关系。方法:回顾分析42例急性重症胰腺炎患者的病例资料,按胰腺增大、胰周及胰外间隙扩散范围进行CT分级,分析CT分级(Ⅱ～Ⅳ级)与临床Ranson评分标准[R1(0～2分),R2(3～5分),R3(>6分)]及预后因素(死亡人数、手术例数、非手术例数)的相关性。结果:病变范围的CT分级Ⅱ级且临床Ranson评分与R1～R2级者16例,病程相对平稳;同属于Ⅲ～Ⅳ级和R2～R3级者共21例,病程迁延、反复、并发症多,病情危重;介于中间者,同属于CT分级Ⅲ级和R1级者共5例。病变范围的CT分级与临床Ranson评分标准呈正相关(r=0.429,P=0.005)。CT分级Ⅱ级16例均采用非手术治疗;Ⅲ级14例中10例采用非手术治疗,3例手术,1例死亡;Ⅳ级12例中1例采用非手术治疗,7例手术,4例死亡。病变范围CT分级与临床预后间呈正相关(r=0.711,P<0.001)。结论:病变范围的CT分级对急性重症胰腺炎的临床严重程度和预后评估具有重要的作用,与临床Ranson标准结合更能提高早期预后判断的准确性和可靠性。

Objective：To explore the relationship between range of CT diagnostic changes and prognosis of severe acute pancreatitis.Methods：Data of 42 cases with acute severe pancreatitis were reviewed retrospectively.The 4-grade plain CT criterion（CT grade Ⅰ～Ⅳ）was based on the CT signs of the extent of extrapancreatic spaces（retroperitoneal,sub-peritoneal and extra-peritoneal space spreading）,the degree of pancreatic enlargement,and peripancreatic involvement;together with Ranson＇s criterion,prognostic factors（the three indexes of mortatity,operations and non-operations）were assessed and scored,respectively.Rank correlation analysis was carried out by adoption of SPSS 11.05 software.Results：16 cases with comparative stable state showed CT grade Ⅱ and Ranson＇s R1 and R2;21 cases with delayed,recurrert and complicated severe conditions belonged to CT grade Ⅲ~Ⅳ and Ranson＇s R2~R3;another 5 cases belonged to CT grade Ⅲ and Ranson＇s R1,representing the intermediate type.The positive correlation lied between the CT grading and Ranson＇s score,that is the higher CT grading,the higher Ranson＇s scoring（r=0.429,P=0.005）.Sixteen cases of CT grade Ⅱ were treated non-operatively.Among 14 cases of CT grade Ⅲ,ten adopted the non-operating treatment,3 with surgery and the last one died.12 cases of CT grade Ⅳ included one with non-operation,seven accepted operation and the other four died.The range of CT grading changes and clinical prognosis showed positive correlation（r=0.711,P〈0.001）.Conclusion：Range of CT grading changes provide essential emphasis on the clinical severity and prognostic evaluation for patients with acute severe pancreatitis;if combined with clinical Ranson score,the more accurate and reliable early prognosis could be predicted.