胰腺炎脾脏并发症的CT分析

CT Findings of Splenic Complications due to Pancreatitis

目的：明确胰腺炎脾脏并发症的ＣＴ表现及预后。材料与方法：从我院７年间收治的２３２例急性胰腺炎和慢性胰腺炎急性发作的病例中选出有脾脏并发症的病例作为研究对象，共计８例。对照出现脾脏并发症前后ＣＴ所见和变化，着重分析脾脏病变ＣＴ特点、演变过程以及与胰腺炎病变和临床的联系。结果：ＣＴ示７例并发脾梗塞，２例有脾包膜下积液。脾梗塞单发小病灶３例，多发小病灶２例，大病灶１例，弥漫型１例。脾包膜下积液轻、中等量各１例。上述脾实质病变经保守治疗后，ＣＴ随诊显示病变逐渐吸收、缩小或消失。１例并发脾假性动脉瘤，ＣＴ未能及时诊断，后破裂出血，经导管栓塞治疗。结论：（１）胰腺炎脾脏并发症多出现于胰腺炎反复发作或重症胰腺炎病情加重过程中；（２）ＣＴ是发现和随诊胰腺炎脾脏并发症的有效方法；（３）脾实质并发症，特别是脾梗塞和包膜下积液，倾向于保守治疗；（４）胰尾及其周围病变易导致脾脏并发症出现；（５）增强ＣＴ扫描能显示脾假性动脉瘤的征象。

Objective: To study CT findings and natural history of splenic parenchymal complications in patients with pancreatitis. Materials and Methods: Of 232 cases with acute or chronic pancreatitis, encountered in our institute during a period of 7 years, 8 cases had splenic parenchymal complications diagnosed by CT. A comparison study was made between the CT findings before and after the spleen was involved. CT findings of splenic involvement in pancreatitis were retrospectively analyzed and correlated with the clinical data. Results: Splenic infarction was found in 7 cases, demonstrating solitary small lesion in 3, multiple small lesions in 2, massive lesion in 1, and diffuse lesions in 1 case. Subcapsular fluid collection was seen in 2 cases. The complications regressed or even disappeared during conservative treatment. Pseudoaneurysm of splenic artery was complicated in one case, which was ruptured and treated with embolization through catheter. Conclusion: (1) splenic complications due to pancreatitis mainly occur in the course of exacerbation of the disease; (2) CT is useful in detecting the complications and followup observations; (3) most complications, especially infarction and subcapsular fluid collection, can be managed conservatively; (4) splenic parenchymal complications tend to occur in patients with pseudocysts at pancreatic tail; (5) contrast enhanced CT scan can show pseudoaneurysm of splenic artery.