螺旋CT在急性重症胰腺炎外科治疗中的应用价值

Clinical value of spiral CT in the surgical treatment of severe acute pancreatitis

目的 :探讨螺旋CT在急性重症胰腺炎外科治疗中的价值。方法 :对 82例治疗前后均行螺旋CT检查的重症胰腺炎患者的CT征像与治疗方法和疗效进行对照分析。结果 :螺旋CT示梗阻性胆源性胰腺炎、胰周血管受侵犯形成血管瘤、胰腺体尾部的片状和段状坏死以及胰腺囊肿治疗中增大或胰周脓肿形成时手术治疗效果明显好于非手术治疗 (P <0 .0 5 ) ;对广泛的蜂窝织炎、胰头部胰腺坏死、胰周囊肿较多及大量腹水者先行非手术治疗 ,再结合病因及临床资料决定是否延迟手术治疗可获满意疗效。结论 :螺旋CT可在急性重症胰腺炎外科治疗方法的选择及手术时机的确定上提供依据。

Objective To evaluate the clinical value of spiral CT in the surgical treatment of severe acute pancreatitis (SAP). Methods The morphological changes in the spiral CT images of 82 SAP patients were contrasted with the therapeutic methods and the curative effects.Results The operation for obstructive biliogenic pancreatitis, invasive parapancreas vessels forming angioma, piece and segmental necrosis in the body and tail of the pancreas, the enlargement of pancreas cyst during the treatment, and parapancreas abscess diagnosed by the spiral CT images had a significant curative effect compared with the non operation treatment (P<0.05). The satisfactory effect could be gained if a conservative treatment was performed first, and then the delayed operative treatment was carried out according to the etiologic and clinical data for the SAP patients with extensive phlegmona, necrosis in the head of the pancreas, severe parapancreas cyst, and a large amount of ascite. Conclusion Spiral CT can supply the grounds for choosing surgical methods and the surgical opportunity in the treatment of SAP patients.