1、超聲在重型急性胰腺炎中應(yīng)用價值的研究        【中文摘要】目的:探討超聲檢查在重型急性胰腺炎診斷,重癥程度判定及對手術(shù)指征選擇中的應(yīng)用價值。方法:回顧性分析我院2006年1月-2008年6月116例經(jīng)臨床、手術(shù)病理證實的重型急性胰腺炎病例的臨床資料,包括性別、年齡、病因、臨床癥狀、治療措施及療效,對B超,CT及MRI影像檢查結(jié)果進行對比分析;并根據(jù)超聲聲像圖改變,按各種征象存在與否及嚴(yán)重程度予以評分分組,將評分結(jié)果與臨床資料作對照研究。結(jié)果:重型急性胰腺炎發(fā)病的均勻年齡56.6±11.7歲,男:女=

2、1.3:1,40-70歲之間者76例,占65.5%。臨床癥狀主要表現(xiàn)為腹痛(100%,116/116);其次為惡心、嘔吐(75%,87/116)。體征中以腹部壓痛為最常見(87.9%,102/116),其次為腸叫音減弱(31.9%,12/116)。病因分類中膽源性胰腺炎最常見,其次為高脂血癥性和酒精性;膽源性胰腺炎組患者年齡較其他組為大,且女性發(fā)病高于男性;而高脂血癥相關(guān)性與酒精性胰腺炎組男性多于女性。病死率為11.2%。超聲診斷正確率88例(75.8%),CT診斷93例(80.2%),MRI診斷56例(82.4%),超聲及MRI診斷積液靈敏度高于CT。超聲對膽系結(jié)石的檢出率明顯高于CT。均勻

3、住院天數(shù)、手術(shù)例數(shù)隨超聲評分增高而呈增長趨勢。以超聲評分6分列為重癥并與APACHE評分對比研究,發(fā)現(xiàn)與急性胰腺炎的嚴(yán)重程度明顯相關(guān)。B超在膽源性SAP早期治療過程中,可確定膽總管有無擴張、結(jié)石及阻塞指導(dǎo)選擇手術(shù)方式;床邊超聲引導(dǎo)下經(jīng)皮腹腔穿刺置管引流,可改善患者病情;根據(jù)超聲表現(xiàn)判定壞死組織有無感染及胰周膿腫等局部并發(fā)癥的形成,并動態(tài)觀察局部并發(fā)癥的變化以指導(dǎo)和糾正治療方案,可為臨床決定手術(shù)時機及手術(shù)方式提供有價值的信息。結(jié)論:重型急性胰腺炎多發(fā)于40-70歲年齡組,男性多于女性;臨床主要表現(xiàn)為腹痛及惡心嘔吐,體征以上腹壓痛及腸叫音減弱多見;膽源性胰腺炎占首位,其次是高脂血癥及酒精性胰腺炎。

4、超聲、CT及MRI對急性胰腺炎的檢出率比較無統(tǒng)計學(xué)差異,三種檢查方法對SAP患者胰腺大小、形態(tài)、組織結(jié)構(gòu)的改變發(fā)現(xiàn)無統(tǒng)計學(xué)差異,超聲及MRI診斷積液靈敏度高于CT,超聲對膽囊結(jié)石的檢出率明顯高于CT,MRI。應(yīng)用超聲評分法評估急性胰腺炎嚴(yán)重程度快速簡便、正確性較高。在重型急性胰腺炎的治療過程中,B超通過判定有無阻塞可指導(dǎo)膽源性胰腺炎的治療,超聲引導(dǎo)下經(jīng)皮穿刺引流改善患者病情;根據(jù)超聲表現(xiàn)及穿刺涂片找到細菌判定壞死組織有無感染及胰周膿腫等局部并發(fā)癥的形成,并動態(tài)觀察局部并發(fā)癥的變化以指導(dǎo)和糾正治療方案,可為臨床決定手術(shù)時機及手術(shù)方式提供有價值的信息。B超是診斷重型急性胰腺炎的有效方法之一,在重型

5、急性胰腺炎的治療過程中有著很好的臨床應(yīng)用價值。');【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