Dynamic contrast enhanced computed tomography: a precise technique for identifying and localising pancreatic necrosis.
Dynamic contrast enhanced computed tomography: a precise technique for identifying and localising pancreatic necrosis.
复制标题
动态对比增强计算机断层扫描：一种识别和定位胰腺坏死的精确技术。
作者：
M. Larvin;A. Chalmers;M. Mcmahon
目的：评估动态增强ct对急性胰腺炎胰腺坏死的检测和定位。设计：前瞻性评估，盲报扫描结果。环境：单一教学医院。患者——连续60例急性胰腺炎患者，怀疑因主要器官系统衰竭而出现胰腺坏死（13）；入院后5 - 7天恢复缓慢，急性生理和慢性健康评估（APACHE-II）评分升高（27）；或先前超声检查或计算机断层扫描的发现（20）。主要结局指标：组织学证实胰腺坏死，即在剖腹手术（用于危及生命的败血症或腹膜炎）或尸检时清除坏死组织大于30g。结果：动态计算机断层扫描正确定位了11例患者的胰腺坏死（9例剖腹手术证实，2例尸检证实）。9例单纯胰周组织低强化患者中，8例经保守治疗后恢复；尸检证实1例患者胰腺存活，胰腺周围脂肪坏死。在40例对比增强正常的患者中，没有人需要剖腹手术来清除胰腺坏死。结论：动态对比增强计算机断层扫描似乎是一种安全准确的方法来识别和定位胰腺和胰腺周围坏死，这是传统成像技术无法准确预测的。
OBJECTIVE--To evaluate dynamic contrast enhanced computed tomography for detecting and localising pancreatic necrosis in acute pancreatitis. DESIGN--Prospective evaluation with blind reporting of scans. SETTING--Single teaching hospital. PATIENTS--60 Consecutive patients with acute pancreatitis suspected to have pancreatic necrosis because of major organ system failure (13); slow recovery five to seven days after admission with raised scores on the acute physiological and chronic health evaluation (APACHE-II) system (27); or findings on previous ultrasonography or computed tomography (20). MAIN OUTCOME MEASURE--Pancreatic necrosis proved histologically--that is, greater than 30 g necrotic tissue debrided at laparotomy (for life threatening sepsis or peritonitis) or necropsy. RESULTS--Dynamic computed tomography correctly localised pancreatic necrosis in 11 patients (confirmed at laparotomy in nine and at necropsy in two). Of nine patients with low enhancement of peripancreatic tissues alone, eight recovered after conservative management; necropsy confirmed viable pancreas and necrosis of peripancreatic fat in one patient. Of 40 patients with normal contrast enhancement, none required laparotomy to debride pancreatic necrosis. CONCLUSION--Dynamic contrast enhanced computed tomography seems to be a safe and accurate method of identifying and localising pancreatic and peripancreatic necrosis, which cannot be predicted accurately by conventional imaging techniques.