CT诊断感染性重症急性胰腺炎临床分析

CT diagnosis on infectious severe acute pancreatitis: a clinical analysis

目的:探讨重症急性胰腺炎合并感染应用CT扫描诊断准确率。方法:对2011年7月至2014年3月收治的35例确诊重症急性胰腺炎疑似合并感染患者实施螺旋CT扫描,并抽取积液标本实施细菌培养确认感染率,分析CT扫描准确率以及影像学结果,并与单纯性SAP实施CT扫描影像学表现做对比,总结合并感染病例典型CT表现。结果:细菌培养感染率为88.57%,CT扫描诊断感染率为85.71%,两者比较差异无统计学意义(χ2=1.010,P=0.241);CT胰腺肿大突出,周围渗出大量棉絮状物质,且渗出物聚集,炎症蔓延范围大,增强CT图像提示胰腺坏死区呈现无强化或弱强化低密度影,假性气泡及不均匀积液密度是SAP合并感染的典型表现。结论:CT扫描应用于急性重症胰腺炎合并感染患者诊断准确率高,可作为重要诊断手段。

Objective： To investigate the diagnostic accuracy of CT scanning on co-infection of severe acute pancreatitis（ SAP）,to compare them with non-infected CT imaging findings,and to provide a reference for clinical diagnosis.Methods： Thirty-five patients diagnosed with suspected SAP co-infection between July 2011 and March 2014 were included as the subjects in the study. All patients underwent spiral CT scan. Fluid samples were extracted for bacterial culture to confirm infection rate. The accuracy of CT scanning and imaging findings were analyzed,and compared with those of simple SAP. Then,the typical CT imaging findings of SAP co-infection were summarized. Results： The infection rate of bacterial culture was 88.57%,and the infection rate diagnosed by CT scan was 85.71%,without statistically significant difference（ χ2= 1. 010,P = 0. 241）. The CT findings showed prominent and swelling pancreas,and a large number of cotton-like substances around,with aggregation and a large spreading scale of inflammation. The enhanced CT images showed no enhancement or weak enhanced low density imaging in pancreatic necrosis area. False bubbles and uneven fluid density were typical performance of SAP co-infection.Conclusion： CT scanning has a high accuracy rate in diagnosing SAP co-infection,which can be used as an important diagnostic method.