CT诊断胆总管结石并发急性胰腺炎的价值分析

The value analysis of CT in the diagnosis of choledocholithiasis complicated with acute pancreatitis

目的 分析CT诊断胆总管结石并发急性胰腺炎的临床价值。方法 回顾性分析30例胆总管结石并发急性胰腺炎患者临床资料,所有患者均给予CT诊断。观察胰腺形态、梗阻部位、结石密度、梗阻末端形态。结果 急性出血性坏死性胰腺炎患者5例,其CT影像学检查结果显示出密度不均匀,可以发现患者存在出血坏死病灶,且进行增强扫描时,患者CT影像学检查显示不均匀强化,肾脏周围存在部分间隙积液以及胰腺周围组织存在积液。间质水肿型胰腺炎患者25例,其中存在胰腺尾部肿大5例,胰腺头部肿大8例,胰体肿大12例。上段梗阻11例,胰内段梗阻2例,壶腹部梗阻17例。高密度结石19例,略高密度结石8例,混合密度结石3例。14例患者胆总管远端呈现出高密度圆形或者椭圆形的阴影, 3例高密度靶征, 5例略高密度结石呈半圆形突入腔内,并与软组织密度相似,胆总管下端较多, 8例为低混杂密度影。结论 CT检查技术在胆总管结石并发急性胰腺炎诊断中效果明确,可以清晰显示病灶类型和部位,为治疗提供可靠依据,具有临床应用价值。

Objective To analyze the clinical value of CT diagnosis in patients with choledocholithiasis complicated with acute pancreatitis. Methods The clinical data of 30 patients with choledocholithiasis complicated by acute pancreatitis were retrospectively analyzed, and all patients were diagnosed by CT. The morphology of the pancreas, the site of obstruction, the density of stones, and the morphology of the end of the obstruction were observed. Results In 5 patients with acute hemorrhagic necrotizing pancreatitis, their CT imaging findings showed heterogeneous density, and the presence of hemorrhagic necrotic lesions could be detected in the patients, and when enhanced scans were performed, the patients showed heterogeneous enhancement on CT imaging, the presence of partial interstitial fluid around the kidneys and the presence of fluid in the peripancreatic tissue. There were 25 patients with interstitial edematous pancreatitis, of which 5 cases had caudal pancreatic enlargement, 8 cases had head pancreatic enlargement, and 12 cases had body pancreatic enlargement. There were 11 cases of superior segment obstruction, 2 cases of intrapancreatic segment obstruction,and 17 cases of jugular abdominal obstruction. There were 19 cases of high-density stones, 8 cases of slightly high-density stones, and 3 cases of mixed-density stones. 14 patients showed high-density round or oval shadows in the distal common bile duct, 3 cases had high-density target signs, 5 cases had slightly high-density stones protruding into the lumen in a semicircular shape and resembling the density of soft tissues, more in the lower end of the common bile duct, and 8 cases had low-mixed density shadows. Conclusion CT examination has a definite effect in the diagnosis of choledocholithiasis complicated with acute pancreatitis, and can clearly show the type and location of lesions, provide the basis for treatment, which has the value of clinical application.