Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging.
Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging.
复制标题
重症急性胰腺炎胰腺坏死的识别：影像学检查与临床分期。
作者：
S. Block;W. Maier;R. Bittner;M. Büchler;P. Malfertheiner;H. Beger
1981年至1984年，395例急性胰腺炎患者中，有105例在我们诊所接受了手术治疗。其中93例患者在术前接受了造影增强计算机断层扫描和/或超声检查，并根据Ranson客观标准进行了临床评估。术中77例患者表现为坏死性胰腺炎，16例表现为胆源性急性间质性胰腺炎。 90% 的胰腺广泛坏死病例和 79% 的轻度胰腺坏死病例已通过对比增强计算机断层扫描得到证实。 24%的患者因流星雨而无法进行超声诊断；无论该过程的程度如何，胰腺坏死诊断研究的敏感性均为 73%。根据早期客观体征，7 名急性间质性胰腺炎患者被归类为重度发作，而 30 名坏死性胰腺炎患者被归类为轻度发作。我们的结论是，对比增强计算机断层扫描有助于决定急性胰腺炎的保守治疗还是手术治疗。超声似乎不是确定胰腺坏死的适当方法。早期客观体征无法充分识别急性胰腺炎的坏死形式。
One hundred and five of 395 patients with acute pancreatitis were surgically treated in our clinic from 1981 to 1984. Ninety three of these patients were examined with contrast enhanced computed tomography and/or ultrasound and were clinically assessed according to Ranson's objective criteria before operation. At operation, 77 patients showed necrotising pancreatitis and 16 showed biliary acute interstitial pancreatitis. Ninety per cent of the cases with extensive and 79% of those with minor necroses of the pancreas had been demonstrated with contrast enhanced computed tomography. Ultrasound failed to be diagnostic in 24% of the patients due to meteorism; the sensitivity of the diagnostic studies for pancreatic necrosis was 73% regardless of the extent of the process. Using the early objective signs, seven patients with acute interstitial pancreatitis were classified as having a severe attack, whereas 30 patients with necrotising pancreatitis were categorised as mild attacks. We conclude that the contrast enhanced computed tomography is an aid in deciding on conservative or surgical treatment in a case of acute pancreatitis. Ultrasound does not appear to be an adequate method for determining pancreatic necrosis. The early objective signs fail to sufficiently identify the necrotising form of acute pancreatitis.