急性胰腺炎累及小肠系膜腹膜下间隙的多层螺旋CT表现及其与CT严重指数的相关性

摘要

目的:探讨急性胰腺炎累及小肠系膜腹膜下间隙的多层螺旋CT表现及其与CT严重指数(CTSI)的相关性.方法:回顾分析58例行全腹CT增强扫描且符合Balthazar CT分级C级及其以上的经临床实验室检查和(或)手术病理所证实的急性胰腺炎患者的资料,着重观察并记录胰腺的大小、形态、密度及胰周改变,并计算出CTSI评分,以及小肠系膜腹膜下间隙受累情况及其多层螺旋CT表现.结果:(1) 58例患者中,CTSI评分在4 ～ 5分者20例,6 ～ 7分者23例,8 ～ 10分者15例;小肠系膜腹膜下间隙受累者50例,小肠系膜腹膜下间隙积液者13例;(2)小肠系膜腹膜下间隙受累表现为肠系膜水肿增厚、密度增高,系膜血管边缘模糊不清,伴或不伴液体积聚;(3)急性胰腺炎小肠系膜腹膜下间隙积液发生率与其CTSI评分有相关性(P ＜ 0.05).结论:多层螺旋CT可充分显示急性胰腺炎累及小肠系膜腹膜下间隙的情况;其表现可在一定程度上反映急性胰腺炎的严重程度.%Objective To explore multi-slice spiral CT (MSCT) features of acute pancreatitis involving the subperitoneal space of small bowel mesentery (SpSS) and the correlation with CT severity index (CTSI).Methods 58 cases of acute pancreatitis (grade C or above according to Balthazar's criterion) , which were proved by a typical clinical presentation with elevated serum amylase levels and/or pathologic findings , were included in this study. The size , shape and density of the pancreas , the manifestations of peripancreatic inflammation, and the abnormality of SpSS were observed. CTSl scores were computed. Results (1) Of 58 patients, 20 had a CTSI score of 4-5, 23 had 6-7, and 15 had 8-10. SpSS involvement develped in 50 patients and fluid collection in SpSS in 13. (2) The typical CT appearance of SpSS involvement was presented as edema, thickening, misty density, and blur margin of mesenteric vessels , with or without fluid collection in SpSS. (3) The incidence of fluid collection in SpSS was associated with CTSI (P ＜ 0.05). Conclusions MSCT can demonstrate the details of SpSS involvement in acute pancreatitis , which may reflect the severity of acute pancreatitis in a certain extent.