CT引导下细针穿刺早期诊断急性坏死性胰腺炎继发感染

目的 探讨应用ＣＴ引导下细针穿刺（ＦＮＡ）早期诊断急性坏死性胰腺炎继发感染的方法。;方法 对１４例临床怀疑有继发感染的急性坏死性胰腺炎患者行ＣＴ引导下ＦＮＡ。抽吸物行涂片革兰染色、细菌培养以及聚合酶链反应（ＰＣＲ）细菌检测。结果 １０例最终诊断为胰腺感染,４例最终诊断为胰腺未感染,共行ＦＮＡ１５例次,其中,１２例次经左侧腹膜后穿刺,１例次同时行左侧和右侧腹膜后穿刺,２例次经腹腔穿刺,与最终诊断结果比较,ＦＮＡ抽吸物涂片、ＰＣＲ、培养诊断胰腺感染的敏感性分别为７／１０、９／１０、１０／１０,特异性均为４／４,需要时间分别为３０ｍｉｎ、４ｈ、３ｄ。结论 对多数急性坏死性胰腺炎患者可选择腹膜后路径行ＣＴ引导下ＦＮＡ,以避开胃肠和重要脏器;抽吸物ＰＣＲ诊断胰腺感染,快速准确,适应临床快速诊断胰腺感染的要求。

CT guided percutaneous fine needle aspiration for early diagnosis of pancreatic infection after acute necrotizing pancreatitis

OBJECTIVE: To assess CT-guided percutaneous fine needle aspiration (FNA) for early diagnosis of pancreatic infection after acute necrotizing pancreatitis. METHODS: CT-guided percutaneous FNA was employed to diagnose pancreatic infection after acute necrotizing pancreatitis in 14 patients. The aspirates were smeared, cultured and subjected polymerase to chain reaction (PCR) for detecting bacteria. RESULTS: Ten patients were diagnosed as having pancreatic infection and 4 non-pancreatic infection. FNA was totally performed for 15 times: left retroperitoneal route for 12 times, left and right retroperitoneal route for one time, and transperitoneal route for two times. The sensitivity of smear, PCR, culture to diagnose pancreatic infection was 7/10, 9/10, 10/10, respectively. Their specificity was 4/4, and the time for obtaining the results was 30 minutes, 4 hours, 3 days respectively. CONCLUSIONS: Retroperitoneal approach can be used for most patients with acute necrotizing pancreatitis when performing CT guided-percutaneous FNA. PCR of aspirates is a rapid and accurate method to diagnose pancreatic infection.