急性胰腺炎胰外并发症的CT表现

目的 探讨急性胰腺炎（AP）胰外并发症的CT征象对判断AP严重程度的价值。方法 收集89例AP患者的临床资料和CT片，分析AP时胰腺外组织或器官并发症的发生率及CT征象。结果 89例AP中30例（33．7％）CT扫描仅见胰周组织坏死，59例（66．3％）显示胰外并发症，其中6例（6．7％）出现腹腔血管并发症，包括5例腹腔积血和1例胰周动脉瘤；1例（1．1％）并发肝脓肿；52例（58．4％）显示腹水，其中合并胸水29例（32．6％），心包积液2例（2．2％），肺底局限性片状炎症渗出7例（7．9％）；15例（16．9％）并发肺水肿，其中11例（12．4％）进展为成人呼吸窘迫综合征（ARDS）后死亡。结论 AP时腹部血管破裂或栓塞、胸腹水及肺部ARDS是严重的并发症，这些并发症的CT征象是判断AP严重程度的重要指标。

CT presentation of complications out of the pancreas in patients with acute pancreatitis

Objective To evaluate the value of CT presentation of out-of-pancreas complications on judging the severity of acute pancreatitis (AP). Methods Clinical data and CT films of 89 AP patients were analyzed retrospectively and special attention was paid to CT presentation of complications out of the pancreas. Results 6(7%) of the 89 patients presented with abdominovascular complications, including hematocelia in 5 patients and parapancreatic aneurysm in the remaining patient. Liver abscess was found in one patient (1%), ascites in 52 patients (58%), pleural effusion in 29 patients (33%), pulmonary edema in 15 patients (17%), pericardial effusion in 2 patients, and local pneumonia of inferior lobe in 7 patients. 11 patients (12%) progressed to acute respiratory distress syndrome (ARDS) and died finally. 30 of the 89 patients only showed complications in the pancreas and peripancreatic tissues. Conclusions The out-of-pancreas morbidity rate in AP was 66%. Abdominovasular abnormalities, ascites, pleural effusion and ARDS were the most severe complications. Abdominal CT enhancement has important significance for diagnosis of AP prognosis, and can serve as a clinical indication of severe degree of acute pancreatitis.