活动性肝硬化患者胰腺声像图变化及其意义

Change and significance of pancreas ultrasonogram in patients with active liver cirrohsis.

目的 探讨在活动性肝硬化患者中,胰腺的声像图表现及其意义。方法 肝脏疾病可通过门静脉、淋巴、胆管、胰管等相互联系,以及引起肝脏疾病的酒精、病毒、代谢、营养等因素,在损害肝脏的同时对胰腺也具有损害作用。本文对94例活动性肝硬化患者进行胰腺超声检查。结果 声像图变化主要表现为胰腺肿大37例(39.6％);胰实质回声增强、光点增粗25例(26.60％);胰腺表面不整15例(16.96％);胰管扭曲5例(5.32％);胰头癌伴胰管扩张1例(1.06％)。血淀粉酶测定22例,8例升高(36.36％)。肝硬化组胰头前后径X29.09mm±5.98,胰体前后径X19.41mm±3.70,对照组胰头前后径X21.65mm±3.05,胰体前后径X14.03mm±2.59,经统计学处理有极显著性差异(P<0.001)。结论 认为慢性活动性肝硬化患者的胰腺声像图变化可能与下列因素有关:1.低蛋白血症引起血浆渗透压下降,使血管外液增加。统计结果胰腺大小与血清白蛋白含量呈负相关(P<0.001);2.门脉高压使胰腺静脉回流障碍,使胰腺组织间隙充血、水肿。结果显示胰腺大小与门脉内径呈正相关(P<0.001);3.肝炎病毒在损害肝脏的同时可能也直接损害胰腺;4.病毒抗原抗体反应、免疫复合物沉积,导致免疫损伤;5.病毒性肝炎可造成胆道系统炎性损伤,通过胆管、胰管共同通道累及胰腺;6.

To describe the appearance of ultrasonogram of pancreas in patients with active liver cirrohsis. Methods Ultrasonogram of pancreas was taken in 94 patients with active liver cirrohsis. Results Among 94 patients, pancreas swelling, enhanced echo and rough light spot of pancreas substantia, unregularity of pancreas surface, and tortuous pancreas pipe showed in 37(39.36%) ,25(26.06%) , 15( 16.96%) ,and 5 patients(5.32%),respectively. One patient(1.06%) accompanied with pancreas head cancer with an enlarged pancreas pipe. The thickness of pancreas head and body in the group of active liver cirrohsis were greater than those in control group, respectively(29.09mm ± 5.98 vs 21.65mm± 3.05,19.44mm ± 3.70 vs 14.03mm ± 2.59, both p < 0.001) 0 Blood amylase was detected in 22 patients and an elevated blood amylase was found in 8. Conclusion There was a series of appearance of ultrasonogram of pancreas in patients with active liver cirrohsis. Factors such as hypoalbumia, portal hypertension, bile duct system infection ,and liver damages caused by hepatitis virus and immune response may be associated with the change of ultrasonogram of pancreas in patients with active liver cirrohsis.