摘要
目的:探讨螺旋CT动态增强扫描对急性出血性坏死性胰腺炎的诊断及预后评价。方法:搜集经CT和临床实验室检查明确诊断的,早期均行非手术治疗的72例急性出血性坏死性胰腺炎患者,并进行回顾性分析,首诊均作平扫,于入院后72小时内行CT动态增强扫描。CT影像学表现可分为点片状、段状、胰腺全段坏死,出血可为灶性或弥漫性,坏死部位可分为胰头、体部及尾部,并能发现并发症以及病因,结合患者发热(T≥38℃)、禁食、住院时间以及器官功能受损、假性囊肿形成情况、中转手术及死亡率等对其预后的评价起到了积极的作用。结果:72例中(灶性、弥漫性)出血41例;点片状坏死24例、段状坏死38例、胰腺全段坏死10例,72例CT动态增强扫描中,坏死区域不强化,低密度坏死灶CT值0～25Hu,与正常胰腺有显著的对比。胰腺周围有大量的渗出,其中合并感染14例。假性囊肿16例,胰腺周围、小网膜囊脓肿9例,中转手术19例,死亡8例。结论:急性出血性坏死性胰腺炎的病因及发病机制复杂,死亡率较高,有典型的临床症状及实验室相关指标,螺旋CT动态增强扫描,可根据急性出血性坏死性胰腺炎影像学表现,不仅能明确的诊断,同时为临床早期及时有效的治疗,对判别病情的轻重及预后的评价有着重要的指导意义。
Objective：to explore the spiral CT scan dynamic of acute hemorrhagic necrotizing pancreatitis diagnosis and prognosis. Material ： Collecting clinical laboratory examination by computed tomography（CT） and the early diagnosis and treatment response did 72 cases of acute hemorrhagic necrotizing pancreatitis, and were analyzed retrospectively, first of all cases are made, flat 72 hours after admission CT scan dynamic adept. CT imaging findings can be divided into some flake, section, pancreas, the entire section necrotic, bleeding can be as focal or diffuse, necrotic area can be divided into super - anterior,body and tail,and can be found, and patients with complications and causes fever （T 38℃ or above）, fasting, length of hospital stay, and impaired organ formation, and pseudocyst operation and mortality outcomes assessment on the positive role. Resuits： In 72 cases （ multifocal, diffuse ） bleeding dl cases, Some flake necrosis, 24 cases （38 cases of necrosis, pancreas, the entire section necrotic 10 cases,CT scan dynamic 72 cases in the area of necrosis, not strengthened, low density necrosis in kitchen CT value 0- 25Hu, and significantly compared to normal pancreas. Around the pancreas,lots of exudate amalgamative infection 14 cases. Pseudocyst 16 cases, pancreas, small retinal capsule around 9 cases, transit operation abscess in 19 cases, 8 cases of death. Conclusion： Acute hemorrhagic necrotizing pancreatitis etiology and pathogenesis is complex, high mortality rate, typical of clinical symptoms and relevant index, spiral CT scan, but according to the dynamic acute hemorrhagic necrotizing pancreatitis imaging manifestations, not only can clear diagnosis, and the timely and effective for the clinical treatment of early, the weight of the illness of discrimination and prognosis assessment has important significance.
