创伤性胰腺炎的CT征象

CT Manifestations of Traumatic Pancreatitis

目的创伤性胰腺炎易误诊且死亡率高,本文总结创伤性胰腺炎患者的临床表现和CT征象,以提高对本病的认识。资料与方法回顾性分析经手术或治疗后复查证实为创伤性胰腺炎的25例患者的临床资料和CT图像,根据胰腺实质损伤的深度分为浅表伤(创伤小于胰腺厚度的50%)和深部伤(创伤大于胰腺厚度的50%)。分析两种胰腺损伤类型临床和CT表现及其他脏器伴发损伤情况。结果胰腺浅表伤8例,深部伤17例,9例伴其他部位损伤。深部伤患者的临床表现为钝性中上腹疼、痛漫腹痛、恶心、呕吐,且重于浅表伤患者,动态观察两种损伤类型血清淀粉酶均有不同程度升高。7例延期手术者均出现胰腺假性囊肿、胰液外漏及腹膜炎等相关并发症。8例胰腺表浅伤患者中CT平扫首诊漏诊3例;17例胰腺深部伤中,次全断裂伤12例,完全断裂伤5例,CT平扫首诊漏诊1例。创伤性胰腺炎的CT直接征象为胰腺局限性异常密度区或胰实质连续性中断。结论创伤性胰腺炎的临床表现复杂,CT直接征象为胰腺实质密度不均匀或连续性中断,创伤深度与主胰管损伤密切相关,间接征象需注意胰周渗出及伴发其他脏器损伤。

Purpose Traumatic pancreatitis which has a high mortality rate is likely to be misdiagnosed. This study aims to analyze the clinical manifestations and CT findings of traumatic pancreatitis, so as to improve its early diagnosis and treatment. Materials and Methods The clinical manifestations and CT images of 25 patients with traumatic pancreatitis confirmed by operation or post-treatment review were analyzed retrospectively. Pancreatic injuries were classified as superficial lesions（with the depth of trauma less than 50% of the thickness of pancreas） and deep lesions（with the depth of trauma more than 50% of the thickness of pancreas）. The clinical manifestations, CT findings and the complicated organ injuries in these two types of pancreatic trauma were analyzed. Results Eight patients had superficial lesions, and 17 patients were with deep lesions. Nine patients had complicated organ injuries. Patients with deep lesions showed a more severe abdominal pain, nausea, vomiting, rebound tenderness and muscular tension than those patients with superficial lesions. The serum amylases increased in all the patients. Pancreatic-relevant complications including pancreas pseudocyst, pancreatic fluid leakage and peritonitis occurred in 7 patients who accepted a delayed operation. Three out of 8 patients with superficial pancreatic injuries were missed on plain CT scan in the first time. Among 17 patients with deep pancreatic trauma, 12 had incomplete laceration, 5 had complete laceration, and 1 was missed in the first time. The direct CT features of pancreatic trauma were focal abnormal attenuation and/or discontinuity in pancreatic parenchyma. Conclusion The clinical manifestations of patients with traumatic pancreatitis are complicated. The direct CT features of pancreatic trauma include heterogeneous density of pancreatic parenchyma and/or interruption. Trauma＇s depth is closely related to the main injury of pancreatic duct. It is worth to be aware of the indirect signs such as peripancreatic oozy and other viscera damages.