CT评价急性重症胰腺炎预后的价值

目的：探讨CT对急性重症胰腺炎病变范围的诊断价值及其与预后的关系。方法：回顾分析42例急性重症胰腺炎患者的病例资料,按胰腺增大、胰周及胰外间隙扩散范围进行CT分级,分析CT分级（Ⅱ～Ⅳ级）与临床Ranson评分标准R1（0～2分）,R2（3～5分）,R3（〉6分）]及预后因素（死亡人数、手术例数、非手术例数）的相关性。结果：病变范围的CT分级Ⅱ级且临床Ranson评分与R1～R2级者16例,病程相对平稳;同属于Ⅲ～Ⅳ级和R2～R3级者共21例,病程迁延、反复、并发症多,病情危重;介于中间者,同属于CT分级Ⅲ级和R1级者共5例。病变范围的CT分级与临床Ranson评分标准呈正相关（r=0.429,P=0.005）。CT分级Ⅱ级16例均采用非手术治疗;Ⅲ级14例中10例采用非手术治疗,3例手术,1例死亡;Ⅳ级12例中1例采用非手术治疗,7例手术,4例死亡。病变范围CT分级与临床预后间呈正相关（r=0.711,P〈0.001）。结论：病变范围的CT分级对急性重症胰腺炎的临床严重程度和预后评估具有重要的作用,与临床Ranson标准结合更能提高早期预后判断的准确性和可靠性。

CT evaluation for prognosis of severe acute pancreatitis

Objective：To explore the relationship between range of CT diagnostic changes and prognosis of severe acute pancreatitis.Methods：Data of 42 cases with acute severe pancreatitis were reviewed retrospectively.The 4-grade plain CT criterion（CT grade Ⅰ～Ⅳ）was based on the CT signs of the extent of extrapancreatic spaces（retroperitoneal,sub-peritoneal and extra-peritoneal space spreading）,the degree of pancreatic enlargement,and peripancreatic involvement;together with Ranson＇s criterion,prognostic factors（the three indexes of mortatity,operations and non-operations）were assessed and scored,respectively.Rank correlation analysis was carried out by adoption of SPSS 11.05 software.Results：16 cases with comparative stable state showed CT grade Ⅱ and Ranson＇s R1 and R2;21 cases with delayed,recurrert and complicated severe conditions belonged to CT grade Ⅲ~Ⅳ and Ranson＇s R2~R3;another 5 cases belonged to CT grade Ⅲ and Ranson＇s R1,representing the intermediate type.The positive correlation lied between the CT grading and Ranson＇s score,that is the higher CT grading,the higher Ranson＇s scoring（r=0.429,P=0.005）.Sixteen cases of CT grade Ⅱ were treated non-operatively.Among 14 cases of CT grade Ⅲ,ten adopted the non-operating treatment,3 with surgery and the last one died.12 cases of CT grade Ⅳ included one with non-operation,seven accepted operation and the other four died.The range of CT grading changes and clinical prognosis showed positive correlation（r=0.711,P〈0.001）.Conclusion：Range of CT grading changes provide essential emphasis on the clinical severity and prognostic evaluation for patients with acute severe pancreatitis;if combined with clinical Ranson score,the more accurate and reliable early prognosis could be predicted.