胰周血管改变在急性胰腺炎改良CT严重指数分级中的价值

Value of peripancreatic vasculopathy for MCTSI classification in acute pancreatitis

目的观察急性胰腺炎胰周血管改变的影像表现,统计胰周血管改变发生率,探讨胰周血管CT改变在急性胰腺炎改良CT严重指数(MCTSI)分级中的价值。方法对2013年1月至2016年12月安徽医科大学第二附属医院检查的173例急性胰腺炎(AP)患者的CT增强影像资料进行回顾性分析,对AP并发胰周血管改变,如胰头动静脉弓、脾动、静脉、门静脉、肠系膜上动、静脉出现的增粗、管壁毛糙、受压性改变、狭窄/闭塞、血栓形成以及侧枝循环形成等的CT异常表现进行统计分析。并参照MCTSI将血管并发症作为评分标准之一对AP严重程度进行分级。结果 173例AP患者中出现胰周血管改变84例(48.55%),143次血管损伤。其中以脾静脉病变发生率较高,占25.17%。胰周血管改变的发生率在不同严重程度AP中差异有统计学意义(P<0.001)。所有出现胰周血管改变的病例中,仅1例未合并其他胰周血管改变。结论 AP患者胰周血管改变常累及多支血管且具有多种CT表现,不同严重程度AP中胰周血管改变的发生频率不同,并与MCTSI分级具有较高的一致性,详细评价血管变化有助于判断AP严重程度。

Objective To observe the imaging manifestation of peripancreatic vasculopathy in acute pancreatitis, the rate of vasculopathy and explore the value of peripancreatic vessels in acute pancreatitis MCTSI by CT image. Methods The image data of 173 patients who underwent CT enhancement scan in our hospital were retrospectively analyzed. CT imaging features in the rate of arteriovenous bow of the pancreas head, spleen vascular, portal vein, superior mesenteric arteries diameter enlargement, vessel wall coarseness, compression change, stenosis/occlusion, thrombus and collateral circulation were statisitcally analysed.Vasculopathy was conisdered one of MCTSI classification criteria to classify the degree of AP. Results 84 cases of vasculopathy occurred in 173 acute pancreatitis （48.55%）, with 143 times vascular injury, in which there was a higher incidence of splenic vein, accounting for 25.17%. The incidnece of vasculopathy was statistically different in different severity of AP（P〈0.05）. In all cases of vasculopathy, only one case presented no other peripancreatic complications. Conclusion Peripancreatic vasculopathy often involves many vessels with multiple CT performance. Different severity of AP vasculopathy occurs in different frequency and has high consistency with MCTSI classification. Detailed observation of vascular changes helps to evaluate the severity of SAP.