胰腺损伤的CT征象

CT findings of blunt pancreatic trauma

目的 总结胰腺损伤的CT征象 ,评价CT在胰腺损伤中的诊断作用。方法 总结分析我院 1997.5～ 2 0 0 1.7间急性闭合性腹部外伤 ,经手术证实伴胰腺损伤的病例 2 1例。其中男 15例 ,女 6例 ,年龄在 7～ 5 0岁之间 ,平均年龄 2 5 6岁。结果 在 2 1例胰腺损伤中 ,7例首诊CT显示无明显异常。另 14例胰腺损伤的CT表现有以下几种类型 :①胰腺炎型 :局限水肿型 (6例 )。弥漫性急性胰腺炎型 (3例 )。②胰腺断裂型 (4例 ) :CT平扫可见胰腺缺口和横行的低密度影。③胰腺血肿 (1例 )。在未进行手术处理的患者 (4例 ) ,在随访CT见胰腺炎伴假性胰腺囊肿形成。胰周渗出表现 17例。合并胰腺以外损伤 15例。 5 / 7例在早期CT影像中难以识别有无主胰管损伤。结论 胰腺损伤的CT征象包括 :①直接征象 :创伤后的胰腺弥漫性和局限性肿大 ,胰腺低密度裂口 ,胰腺内高密度影。随访中可见胰腺内假性囊肿形成。②间接征象 :胰腺周围积液是重要的间接征象。主胰管损伤的CT诊断是困难的。胰腺创伤后立即CT检查可表现“正常” ,合并伤也易导致诊断困难。

Objective To find the CT features of pancreatic trauma and its role in the diagnosis. Methods Twenty one consecutive patients, 15 males and 6 females with mean age of 25.6 years ranging from 7 to 50, who underwent abdominal CT following blunt pancreatic trauma and surgically diagnosed as pancreatic injury or clinical pancreatitis between 1997 and 2001 were subjected in this study. Results The pancreatic injury was identified by CT scans in 14 cases. Seven patients who had normal appearing pancreases on CT scan were confirmed to have pancreatic injury with laparotomy or clinical pacreatitis followed up. The type of CT manifestations of pancreatic injury included: (1)pancreatitis,partial in 6 and diffuse in 3 cases;(2)pancreatic transection in 4 cases;(3)pancreatic hematoma in 1. Eight patients not undergoing laparotomy had pancreatitis and/or pancreatic pseudocysts on follow up imaging. Peripancreatic fluid collections on CT were noted in 17 patients. Conclusion CT signs of pancreatic injury include(1)direct signs,such as focal or diffuse pancreas enlargement,contour irregularity,linear area of low attenuation and/or separation,mass with hemorrhage and pesudocyst after trauma in pancreas.(2)indirect signs,such as loss of definition of adjacent fat planes,peripancreatic fluid collections. Pancreatic injury may have a normal appearing pancreas on immediate CT. CT diagnosis of pancreatic injury is difficult when there are associated injury. Follow-up CT is useful in diagnosis of pancreatic injury.