创伤性胰腺炎首诊临床表现及CT影像学表现

The manifestation and CT imaging findings of traumatic pancreatitis at the first time of diagnosis

目的：总结创伤性胰腺炎患者的临床和CT表现，以提高对本病的认识并进行及时治疗。方法回顾性分析经手术及临床治疗后证实为创伤性胰腺炎的13例患者临床资料和CT影像。结果胰腺浅表伤9例，深部伤4例，7例伴其它部位损伤。浅表伤患者临床表现为钝性中上腹痛，4例伴恶心呕吐；深部伤患者临床表现为钝性中上腹疼，均无恶心呕吐。实验室检查：24～48 h内首次检查，两种损伤类型患者的血清淀粉酶、脂肪酶及白细胞、中性粒细胞数均有不同程度升高。9例胰腺表浅伤患者中首诊CT平扫漏诊3例；4例胰腺深部伤中，次全断裂伤2例，完全断裂伤1例，局部断裂伴血肿形成1例。结论创伤性胰腺炎的临床表现复杂，患者血清淀粉酶及脂肪酶均有不同程度升高。创伤性胰腺炎的CT直接征象表现为胰腺局限性异常密度区或胰实质连续性中断、胰腺局部肿大，间接征象主要表现为胰腺局部边缘模糊、胰周渗出性改变及伴发其它脏器损伤。

Objective This study aims to analyze the clinical manifestations and CT findings of traumatic pancreatitis,so as to improve its early diagnosis and treatment.Methods The clinical manifestations and CT images of 13 patients with traumatic pancreati-tis confirmed by operation or post-treatment review were analyzed retrospectively.Results Of the 13 patients,9 patients had superfi-cial lesions and 4 patients were with deep lesions.In addition,7 patients had complicated organ injuries.Patients with superficial le-sions showed a blunt upper abdominal pain in which 4 patients had nausea and vomiting.Patients with deep lesions showed a blunt up-per abdominal pain and none of them had nausea or vomiting.The first laboratory examination within 24-48 hours revealed that serum AMY,LIPA,WBC and NEU were elevated at different degree.In the 9 patients with superficial lesions,3 cases were missed on plain CT scan at the first time.Among the 4 patients with deep pancreatic trauma,2 had incomplete laceration,1 case had complete lacera-tion and 1 case had partial laceration with hematoma formation.Conclusion The clinical manifestations of patients with traumatic pan-creatitis are complicated.The levels of AMY and LIPA are increased to different extent.The direct CT features of pancreatic trauma are focal abnormal density,partial pancreas swelling and/or discontinuity in pancreatic parenchyma.The indirect signs of pancreatic trauma were focal edge blur,peripancreatic exudative change or/and the complicated organ injuries.