CT引导下经皮穿刺抽液引流诊治急性胰腺炎局部并发症(附24例报告)

目的:探讨CT引导下经皮穿刺抽液和/或外引流在诊治急性胰腺炎局部并发症中的临床应用价值。方法:回顾分析2002年3月至2006年12月在我院行CT引导下经皮穿刺诊治的急性胰腺炎局部并发症的24例患者的临床资料,其中急性液体积聚6例、胰腺坏死3例、胰周脓肿6例、假性胰腺囊肿9例。检查穿刺液是否伴感染、含淀粉酶情况,随访临床症状、引流效果和影像学的改变。结果:共穿刺28例次,穿刺成功率100%,20/24例(83.33%)穿刺抽出积液后感局部胀痛缓解。可及时确诊感染性坏死,但引流效果差。2/6例(33.33%)胰周脓肿穿刺引流后治愈,4/6例引流效果差需开腹手术。5/9例(55.56%)假性胰腺囊肿经1.5～6月外引流后治愈拔管,4/9例(44.44%)转行内引流术。结论:CT引导下穿刺检查和外引流成功率高,并发症少。通过穿刺可明确是否伴有感染、了解引流物的性状,为制定治疗方案提供依据,可安全用于诊断和治疗一些急性胰腺炎的局部并发症。

Imaging lexicon for acute pancreatitis:2012 Atlanta Classification revisited

The original 1992 Atlanta Classification Systemfor acute pancreatitis was revised in 2012 by the Atlanta Working Group,assisted by various national and international societies,through web-based consensus.This revised classification identifies two phases of acute pancreatitis:early and late.Acute pancreatitis can be either oedematous interstitial pancreatitis or necrotizing pancreatitis.Severity of the disease is categorized into three levels:mild,moderately severe and severe,depending upon organ failure and local/systemic complications.According to the type of pancreatitis,collections are further divided into acute peripancreatic fluid collection,pseudocyst,acute necrotic collection,and walled-off necrosis.Insight into the revised terminology is essential for accurate communication of imaging findings.In this review article,we will summarize the updated nomenclature and illustrate corresponding imaging findings using examples.