摘要：
Objective To study the portal venous systemic thrombosis (PVST) in early acute pancreatitis (AP) and its correlations with the classification and severity of AP. Methods A total of 396 patients with AP were admitted to the affiliated hospital of north sichuan medical college from January 2013 to May 2017 and underwent MRI in the early stage of AP. PVST was evaluated on the T1WI, T2WI fat-suppression, and dynamic-enhancement sequences. Evaluating the MR imaging, AP was graded as mild, moderate, and severe AP based on the MR severity index (MRSI) and was also classified into interstitial edematous AP and necrotizing AP. According to the New Revised Classification of AP 2012, AP in the clinic setting was graded as mild, moederately severeand severe AP. χ2 test or Fisher exact test calculated the differences of the prevalence of PVST in different severity and classification of AP, Mann-Whitney U test calculated the difference of hospitalization time between patients with PVST and those without PVST. Results Among the 396 patients with AP, PVST was detected in 30 patients (7.5％,30/396), it formed most frequently in splenic vein(73.3％, 22/30), followed by portal (30.0％, 9/30) and superior mesenteric(16.7％, 5/30) veins. According to MRSI, there were 205, 177, and 14 patients with mild, moderate, and severe AP, respectively;among mild, moderate, and severe AP, there were 2, 21, and 7 patients with PVST, respectively (χ2=41.455, P0.05). Three hundred and eleven patients had interstitial edematous AP and 65 patients had necrotizing AP, among which there were 11 and 19 patients with PVST(χ2=48.447,P0.05). Patients with PVST and those without PVST in the early AP, the hospitalization time [median (interquartile range)] were 18 (13 to 22) days and 13 (10 to 19) days (Z=-2.913, P=0.004). Conclusion PVST in early AP presented more frequently with the increase in severity of AP based on both the MRSI and Newly Revised Classification of AP 2012, along with longer duration ofhospitalization.%目的 探讨早期急性胰腺炎(AP)患者合并门静脉系统血栓形成的发生率及其与AP分型、严重程度的关系.方法 回顾性分析2013年1月至2017年5月川北医学院附属医院396例早期AP患者的临床及MRI资料.患者行T1WI、T2WI脂肪抑制、动态增强扫描观察门静脉系统血栓形成情况.观察MRI表现,根据MR严重程度指数(MRSI)评分分为轻症、中症、重症AP;进行分型,分为间质水肿型和坏死型;按照2012亚特兰大标准,进行AP临床严重程度分级,分为轻症、中度重症、重症AP.采用χ2检验、Fisher确切概率法评价门静脉系统血栓形成发生率在AP不同严重程度及分型之间的差异,采用Mann-Whitney U检验评价早期AP合并与未合并门静脉系统血栓形成患者住院时间的差异.结果 396例AP中,30例(7.5％,30/396)出现门静脉系统血栓,其中脾静脉血栓形成22例(73.3％,22/30)、门静脉血栓形成9例(30.0％,9/30)、肠系膜上静脉血栓形成5例(16.7％,5/30).根据MRSI评分,轻症、中症、重症AP患者分别为205、177、14例,门静脉系统血栓形成患者分别为2、21、7例,差异有统计学意义(χ2=41.455,P0.05).间质水肿型331例、坏死型65例,其中门静脉系统血栓形成患者分别为11、19例,差异有统计学意义(χ2=48.447,P0.05).早期合并及未合并门静脉系统血栓形成AP患者的住院时间分别为18(13～22)d及13(10～19)d,差异有统计学意义(Z=-2.913,P=0.004).结论 早期AP合并门静脉系统血栓形成随MRSI、2012亚特兰大标准中严重程度增加而增多,且住院时间更长.
