程燕 1 , 宋彬 1 , 徐雋 2 , 閔鵬秋 1 , 劉杰 1 , 吳苾 1
  • 1.四川大學(xué)華西醫(yī)院放射科(成都610041);;
  • 2.四川省第四人民醫(yī)院CT室(成都610016);

目的總結(jié)急性壞死性胰腺炎（acute necrotizing pancreatitis, ANP）的多排螺旋CT（multidetectorrow spiral CT, MDCT）征象； 探討ANP胰腺實質(zhì)壞死程度與腹膜后炎性擴展范圍以及ANP臨床嚴(yán)重程度之間的相關(guān)關(guān)系。
方法前瞻性納入經(jīng)16排MDCT標(biāo)準(zhǔn)化增強掃描并確診為ANP的病例90例，進行胰腺壞死計分和Balthazar分級； 對其中的44例進行了Ranson分級和CT嚴(yán)重指數(shù)（CT severity index, CTSI）計分。在觀察橫斷面CT圖像的同時，還作了多平面重組（multiplanar reformation, MPR）等圖像重建處理。統(tǒng)計學(xué)分析采用χ2檢驗評價關(guān)聯(lián)性。
結(jié)果①90例ANP中胰腺壞死程度＜30%者40例，30%～50%者23例， gt;50%者27例； 胰周脂肪密度改變90例（100%）； 胰周及腹膜后積液78例（86.7%）； 小網(wǎng)膜囊積液12例（13.3%)； 腎前筋膜增厚90例（100%）； 胃后壁腫脹增厚71例（78.9%)； 出現(xiàn)腸郁張87例(96.7%)； 腹腔積液35例(38.9%)； 脾梗死4例(4.4%)； 胸腔積液82例(91.1%)。②90例ANP腹膜后擴展范圍按Balthazar分級，C級12例，D級42例和E級36例，ANP壞死程度分級與Balthazar分級呈正相關(guān)聯(lián)。 ③44例ANP病例按Ranson分級，輕度12例(27.3%)，中度23例(52.3%)，重度9例(20.5%)； CTSI計分分級，輕度0例，中度25例(56.8%)，重度19例(43.2%)，CTSI計分分級與臨床Ranson分級存在正相關(guān)聯(lián)。
結(jié)論MDCT可以清晰顯示ANP的胰腺實質(zhì)壞死和腹膜后擴散等征象； 胰腺實質(zhì)壞死程度與腹膜后擴散范圍之間存在明顯正相關(guān)性； ANP的 CTSI評分與臨床嚴(yán)重度也存在正向關(guān)聯(lián)性。

引用本文： 程燕,宋彬,徐雋,閔鵬秋,劉杰,吳苾. 急性壞死性胰腺炎多排螺旋CT表現(xiàn)：胰腺壞死程度與腹膜后擴展及臨床嚴(yán)重度的關(guān)系. 中國普外基礎(chǔ)與臨床雜志, 2006, 13(1): 110-115. doi: 復(fù)制

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6. Rydberg J, Buckwalter KA, Caldemeyer KS, et al. Multisection CT: scanning techniques and clinical applications [Ｊ]. Radiographics, 2000; 20(6)∶1787.
7. Cohnen M, Poll L, Puttmann C, et al. Radiation exposure in multislice CT of the heart [Ｊ]. Rofo, 2001; 173(4)∶295.
8. Fuchs T, Kachelriess M, Kalender WA. Technical advances in multislice spiral CT [Ｊ]. Eur J Radiol, 2000; 36(2)∶69.
9. Balthazar EJ, Freeny PC, van Sonnenberg E. Imaging and intervention in acute pancreatitis [Ｊ]. Radiology, 1994; 193(2)∶297.
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11. Johnson CD, Stephens DH, Sarr MG. CT of acute pancreatitis: correlation between lack of contrast enhancement and pancreatic necrosis [Ｊ]. AJR Am J Roentgenol， 1991; 156(1)∶93.
12. 宋彬， 徐雋. 急性胰腺炎的CT評價 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志， 2003; 10(6)∶623.
13. Banks PA. Acute pancreatitis: medical and surgical management [Ｊ]. Am J Gastroenterol, 1994; 89(8 suppl)∶S78.
14. Banks PA. Practice guideline in acute pancreatitis [Ｊ]. Am J Gastroenterol, 1997; 92(3)∶377.
15. Blamey SL, Imrie CW, O’Neill J, et al. Prognostic factors in acute pancreatitis [Ｊ]. Gut, 1984; 25(12)∶1340.
16. Agarwal N, Pitchumoni CS. Simplified prognostic criteria in acute pancreatitis [Ｊ]. Pancreas, 1986; 1(1)∶69.
  1. 1. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation [Ｊ]. Radiology， 2002; 223(3)∶603.
  2. 2. Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis [Ｊ]. Radiology， 1990; 174(2)∶331.
  3. 3. Ranson JH, Rifkind KM, Roses DF, et al. Objective early identification of severe acute pancreatitis [Ｊ]. Am J Gastroenterol， 1974; 61(6)∶443.
  4. 4. Fishman EK. From the RSNA refresher courses: CT angiography: clinical applications in the abdomen [Ｊ]. Radiographics， 2001; 21 Spec No∶S3.
  5. 5. Schoenhagen P, Halliburton SS, Stillman AE, et al. Noninvasive imaging of coronary arteries: current and future role of multidetector row CT [Ｊ]. Radiology, 2004; 232(1)∶7.
  6. 6. Rydberg J, Buckwalter KA, Caldemeyer KS, et al. Multisection CT: scanning techniques and clinical applications [Ｊ]. Radiographics, 2000; 20(6)∶1787.
  7. 7. Cohnen M, Poll L, Puttmann C, et al. Radiation exposure in multislice CT of the heart [Ｊ]. Rofo, 2001; 173(4)∶295.
  8. 8. Fuchs T, Kachelriess M, Kalender WA. Technical advances in multislice spiral CT [Ｊ]. Eur J Radiol, 2000; 36(2)∶69.
  9. 9. Balthazar EJ, Freeny PC, van Sonnenberg E. Imaging and intervention in acute pancreatitis [Ｊ]. Radiology, 1994; 193(2)∶297.
  10. 10. Sakorafas GH, Tsiotos GG, Bower TC, et al. Ischemic necrotizing pancreatitis. Two case reports and review of the literature [Ｊ]. Int J Pancreatol, 1998; 24(2)∶117.
  11. 11. Johnson CD, Stephens DH, Sarr MG. CT of acute pancreatitis: correlation between lack of contrast enhancement and pancreatic necrosis [Ｊ]. AJR Am J Roentgenol， 1991; 156(1)∶93.
  12. 12. 宋彬， 徐雋. 急性胰腺炎的CT評價 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志， 2003; 10(6)∶623.
  13. 13. Banks PA. Acute pancreatitis: medical and surgical management [Ｊ]. Am J Gastroenterol, 1994; 89(8 suppl)∶S78.
  14. 14. Banks PA. Practice guideline in acute pancreatitis [Ｊ]. Am J Gastroenterol, 1997; 92(3)∶377.
  15. 15. Blamey SL, Imrie CW, O’Neill J, et al. Prognostic factors in acute pancreatitis [Ｊ]. Gut, 1984; 25(12)∶1340.
  16. 16. Agarwal N, Pitchumoni CS. Simplified prognostic criteria in acute pancreatitis [Ｊ]. Pancreas, 1986; 1(1)∶69.