重症急性胰腺炎胸部影像学表现对其诊断及预后的价值

目的分析重症急性胰腺炎(SAP)的胸部X线及CT表现,探讨SAP并发急性肺组织损伤的机理及联系,提高其对SAP临床诊断和预后价值的认识.方法对临床及胰腺CT诊断的39例SAP行X线胸片检查,其中11例加做胸部CT,所有病例均有3次以上的X线胸片复查.男17例,女22例,年龄26～64岁.结果在胰腺CT诊断SAP时显示腹水34例,同时胸片及胸部CT出现肺水肿征象者16例(41%),24h内出现者24例(61.5%),48h内出现者37例(94.9%),72h内均出现上述征象.共出现胸水19例.16例最早出现肺水肿征象者中11例有胸水,1例合并心包积液,10例发展为成人呼吸窘迫综合征(ARDS),死亡7例.结论SAP的胸部影像表现对提示ARDS的早期诊断和预后有重要意义,亦可作为判断SAP病变严重程度的临床指标之一.

The Value of Diagnosis and Prognosis of Chest Imaging Feature for Severe Acute Pancreatitis

Objective To study mechanism and relationship of acute lung injury that be complicated with severe acute pancreatitis(SAP).To analyze the chest imaging feature of X-ray and CT of SAP and improve the recognition of clinical value of diagnosis and prognosis.Methods Thirtynine SAP patients(17 male,22 female)age ranged from 26 to 64 of SAP that be diagnosed by clinic and CT were analysed retrospectively.All cases were checked by chest X-ray film and rechecked at least three times,of them chest CT were taken in 11 cases.Results Ascites was found in 34 cases,pleural effusion was found in 19 cases.Pulmonary edema sign of X-ray and CT was found in 16(41%) cases when SAP was diagnosed by pancreas CT.The sign was found in 24(61.5%) cases in 24 hours and in 37(94.9%)cases in 48 hours and all cases in 72 hours.In the 16 early pulmonary edema cases,There were pleural effusion in 11 and pericardiac effusion in one case,10 cases of them developed to acute respiratory distress syndrome(ARDS)and 7 cases died.Conclusion The chest imaging feature of SAP has important significance for early diagnosis of ARDS and prognosis of SAP,and can be served as a clinical indication of severe degree of SAP.