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目的探讨急性胰腺炎(AP)脾并发症的CT表现,评价螺旋CT对其诊断的价值。方法①对139例AP患者的临床、手术资料和CT表现做对照分析,重点观察患者脾异常改变和腹腔大出血的CT表现。②51例AP脾并发症患者与对照组88例AP患者用Ranson评分和Balthazar CT分级行重症发生率的比较。结果①在51例AP脾并发症患者中见:37例脾梗塞(2例继发脾脓肿),19例脾包膜下积液、出血,11例腹腔大出血(包括4例上消化道出血),增强CT发现胃底静脉曲张7例,脾动脉及腹腔动脉假性动脉瘤各1例。②Ranson评分和Balthazar CT分级比较:AP脾并发症组,B1 19例,B2 21例,B3 11例;D级9例,E级25例。对照组分别为55,20,13例和13,18例。2组AP严重度的比较具有显著性差异(Ρ<0.01)。结论①AP的脾并发症强烈提示急性胰腺炎的严重性。②增强螺旋CT有益于显示AP脾并发症,特别是脾血管性病变。
Objective To investigate the CT findings of splenic complications of acute pancreatitis (AP) and evaluate the value of spiral CT in its diagnosis. Methods ① The clinical data and CT findings of 139 AP patients were analyzed comparatively. The CT findings of abnormal changes of spleen and peritoneal hemorrhage were observed. ② Comparison of Ranson score and Balthazar CT grading in 51 AP patients with splenic complications and 88 control patients with control group. Results ① In 51 patients with AP splenic complications, 37 cases of splenic infarction (2 cases of secondary splenic abscess), 19 cases of splenic effusion, hemorrhage and 11 cases of peritoneal hemorrhage (including 4 cases of upper gastrointestinal bleeding) , Enhanced CT findings of gastric varicosis in 7 cases, splenic artery and abdominal artery pseudoaneurysm in 1 case. ②Ranson score and Balthazar CT classification: AP splenic complications group, B1 19 cases, B2 21 cases, B3 11 cases; D grade in 9 cases, E grade in 25 cases. Control group were 55,20,13 cases and 13,18 cases. There was a significant difference in AP severity between the two groups (P <0.01). Conclusions ① The splenic complications of AP strongly suggest the severity of acute pancreatitis. ② enhanced helical CT is beneficial to show AP splenic complications, especially splenic vascular disease.