重症急性胰腺炎时胰腺血管造影的影像学表现及其临床意义

Features of pancreatic angiograms in patients with severe acute pancreatitis and their clinical significance

目的 探讨重症急性胰腺炎时胰腺血管造影的影像学表现及其临床意义。方法 对25例重症急性胰腺炎病人和20例胰腺无疾患志愿者,按Seidinger法将导管插入至胃十二指肠动脉行胰腺血管造影。结果 重症急性胰腺炎时胰腺血管造影的影像学表现为:(1)主干动脉/分支动脉的直径比增大;(2)“树枝状”结构的“树枝”数目明显减少;(3)“网络状”结构模糊;(4)胰腺“轮廓”的消失,或成片状、模糊不清。结论 (1)胰腺血管造影是一种比较客观、直观地反映胰腺血供情况的影像学手段;(2)重症急性胰腺炎时,胰腺血管造影有较明显的影像学异常表现;(3)其临床意义在于:对重症急性胰腺炎病情严重度有一定的评估作用;预测区域动脉灌注治疗的疗效;为临床应用改善胰腺微循环药物提供客观的影像学证据。

Objective To investigate the features of pancreatic angiograms in patients with severe acute pancreatitis (SAP). Methods Based on seldinger's method, the gastroduodenal arteries were catheterized in 25 patients with SAP and 20 volunteers without any pancreatic illnesses for angi-ography. Results (1) The ratio of diameter of the major pancreatic artery to that of its branches increased. (2) The number of the 'branch structures' significantly decreased. (3) The 'network structure' was oblique. (4) The pancreatic outline disappeared or was blurred. Conclusions (1) Pancreatic angiography can objectively and directly show pancreatic microcirculation. (2) The pancreatic angiograms in patient with SAP were obviously abnormal. (3) The clinical significance of pancreatic angiography is that it can assess the severity of SAP, forecast the therapeutic efficacy of regional intra-arteri-al infusion for SAP and provide objective image evidence for use of drugs ameliorating pancreatic microcirculation.