超声在重型急性胰腺炎中应用价值的研究

1、超声在重型急性胰腺炎中应用价值的研究        【中文摘要】目的:探讨超声检查在重型急性胰腺炎诊断,重症程度判定及对手术指征选择中的应用价值。方法:回顾性分析我院2006年1月-2008年6月116例经临床、手术病理证实的重型急性胰腺炎病例的临床资料,包括性别、年龄、病因、临床症状、治疗措施及疗效,对B超,CT及MRI影像检查结果进行对比分析;并根据超声声像图改变,按各种征象存在与否及严重程度予以评分分组,将评分结果与临床资料作对照研究。结果:重型急性胰腺炎发病的均匀年龄56.6±11.7岁,男:女=

2、1.3:1,40-70岁之间者76例,占65.5%。临床症状主要表现为腹痛(100%,116/116);其次为恶心、呕吐(75%,87/116)。体征中以腹部压痛为最常见(87.9%,102/116),其次为肠叫音减弱(31.9%,12/116)。病因分类中胆源性胰腺炎最常见,其次为高脂血症性和酒精性;胆源性胰腺炎组患者年龄较其他组为大,且女性发病高于男性;而高脂血症相关性与酒精性胰腺炎组男性多于女性。病死率为11.2%。超声诊断正确率88例(75.8%),CT诊断93例(80.2%),MRI诊断56例(82.4%),超声及MRI诊断积液灵敏度高于CT。超声对胆系结石的检出率明显高于CT。均匀

3、住院天数、手术例数随超声评分增高而呈增长趋势。以超声评分6分列为重症并与APACHE评分对比研究,发现与急性胰腺炎的严重程度明显相关。B超在胆源性SAP早期治疗过程中,可确定胆总管有无扩张、结石及阻塞指导选择手术方式;床边超声引导下经皮腹腔穿刺置管引流,可改善患者病情;根据超声表现判定坏死组织有无感染及胰周脓肿等局部并发症的形成,并动态观察局部并发症的变化以指导和纠正治疗方案,可为临床决定手术时机及手术方式提供有价值的信息。结论:重型急性胰腺炎多发于40-70岁年龄组,男性多于女性;临床主要表现为腹痛及恶心呕吐,体征以上腹压痛及肠叫音减弱多见;胆源性胰腺炎占首位,其次是高脂血症及酒精性胰腺炎。

4、超声、CT及MRI对急性胰腺炎的检出率比较无统计学差异,三种检查方法对SAP患者胰腺大小、形态、组织结构的改变发现无统计学差异,超声及MRI诊断积液灵敏度高于CT,超声对胆囊结石的检出率明显高于CT,MRI。应用超声评分法评估急性胰腺炎严重程度快速简便、正确性较高。在重型急性胰腺炎的治疗过程中,B超通过判定有无阻塞可指导胆源性胰腺炎的治疗,超声引导下经皮穿刺引流改善患者病情;根据超声表现及穿刺涂片找到细菌判定坏死组织有无感染及胰周脓肿等局部并发症的形成,并动态观察局部并发症的变化以指导和纠正治疗方案,可为临床决定手术时机及手术方式提供有价值的信息。B超是诊断重型急性胰腺炎的有效方法之一,在重型

5、急性胰腺炎的治疗过程中有着很好的临床应用价值。');【Abstract】 Objective Explore the applicative value of ultrasound in diagnosing severe acute pancreatitis,judging severity and choosing operation indication.Methods Clinical data of 116 cases of severe acute pancreatitis in our hospital from Jan.2006 to Jun.2008 which we

6、re proved by clinical examination,surgical pathology were retrospective analyzed.The data included the patients' gender,age, etiology,clinical symptom,procedure of treatment,curative result.And the findings of ultrasound,CT and MRI were compared analyzed.According to ultrasound findings,everyone

7、 was given a mark based on the degree of the imaging changes and was classified into group according to their own score.Comparative study was done between the ultrasonic score and clinical data.Result In severe acute pancreatitis patients,the mean age was 56.6±11.7 years,* ratio was 1.3:1,the n

8、umber of patients from 30 to 70 years was 76(65.5%).The most common clinical symptom was abdominal pain(100%),then nausea(75%) and Vomiting(75%);The most common physical examinations was abdominal tenderness(87.9%),hypoactive bowel sounds(31.9%).The main etiological factor was biliary system disease

9、,hyperlipidemic and alcohol.There was no statistical difference in diagnostic accurate rate for acute pancreatitis among ultrasound,CT and MRI.The diagnostic sensitivity for ascites fluid in ultrasound and MRI was higher than in CT.The diagnostic sensitivity for biliary system stone in ultrasound wa

10、s higher than in CT.Mean length of hospitalization,operation number was increasing with higher ultrasonic score.Ultrasonic score related to the severity of acute pancreatitis based on6 score as a criterion,comparative study was done between the ultrasonic score and APACHEscore.In early stage therapy

11、 progress of biliary severe acute pancreatitis,ultrasound could judge expand,stone,obstruction in CBD and choose operation style.Ultrasound-guided percutaneous catheter drainage could make the patients' situation better.Accordingto ultrasound judging infection and abscess,dynamic observing local

12、 complications change,we could correct therapy plan,provide valuable information for operation.Conclusion Severe acute pancreatitis frequently happens in people aged from 40 to 70 years old,male is more than female.The most common clinical symptom is abdominal pain,nausea and vomiting;The most commo

13、n physical examinations is abdominal tenderness,hypoactive bowel sounds;There is no statistical difference in diagnostic positive rate for acute pancreatitis among ultrasound,CT and MRI.The diagnostic sensitivity for as cites fluid in ultrasound and MRI is higher than in CT. The diagnostic sensitivi

14、ty for biliary system stone in ultrasound was higher than in CT.Ultrasonic score method is quick,accurate and has practical value in judging the severity of acute pancreatitis.Ultrasound can provide more accurate etiology diagnosis for biliary pancreatitis and evidence for * therapy plan.In early th

15、erapy progress of severe acute pancreatitis,ultrasound can judge obstruction in CBD and choose operation style.Ultrasound-guided percutaneous catheter drainage can make the patients' situation better.According to ultrasound judging infection and abscess,dynamic observing local complications change,we can correct ther