CAJ | 학술논문

目的：创伤性胰腺炎易误诊且死亡率高，本文总结创伤性胰腺炎患者的临床表现和CT征象，以提高对本病的认识。资料与方法回顾性分析经手术或治疗后复查证实为创伤性胰腺炎的25例患者的临床资料和CT图像，根据胰腺实质损伤的深度分为浅表伤（创伤小于胰腺厚度的50%）和深部伤（创伤大于胰腺厚度的50%）。分析两种胰腺损伤类型临床和CT表现及其他脏器伴发损伤情况。结果胰腺浅表伤8例，深部伤17例，9例伴其他部位损伤。深部伤患者的临床表现为钝性中上腹疼、痛漫腹痛、恶心、呕吐，且重于浅表伤患者，动态观察两种损伤类型血清淀粉酶均有不同程度升高。7例延期手术者均出现胰腺假性囊肿、胰液外漏及腹膜炎等相关并发症。8例胰腺表浅伤患者中CT平扫首诊漏诊3例；17例胰腺深部伤中，次全断裂伤12例，完全断裂伤5例，CT平扫首诊漏诊1例。创伤性胰腺炎的CT直接征象为胰腺局限性异常密度区或胰实质连续性中断。结论创伤性胰腺炎的临床表现复杂， CT直接征象为胰腺实质密度不均匀或连续性中断，创伤深度与主胰管损伤密切相关，间接征象需注意胰周渗出及伴发其他脏器损伤。
목적：창상성이선염역오진차사망솔고，본문총결창상성이선염환자적림상표현화CT정상，이제고대본병적인식。자료여방법회고성분석경수술혹치료후복사증실위창상성이선염적25례환자적림상자료화CT도상，근거이선실질손상적심도분위천표상（창상소우이선후도적50%）화심부상（창상대우이선후도적50%）。분석량충이선손상류형림상화CT표현급기타장기반발손상정황。결과이선천표상8례，심부상17례，9례반기타부위손상。심부상환자적림상표현위둔성중상복동、통만복통、악심、구토，차중우천표상환자，동태관찰량충손상류형혈청정분매균유불동정도승고。7례연기수술자균출현이선가성낭종、이액외루급복막염등상관병발증。8례이선표천상환자중CT평소수진루진3례；17례이선심부상중，차전단렬상12례，완전단렬상5례，CT평소수진루진1례。창상성이선염적CT직접정상위이선국한성이상밀도구혹이실질련속성중단。결론창상성이선염적림상표현복잡， CT직접정상위이선실질밀도불균균혹련속성중단，창상심도여주이관손상밀절상관，간접정상수주의이주삼출급반발기타장기손상。
PurposeTraumatic pancreatitis which has a high mortality rate is likely to be misdiagnosed. This study aims to analyze the clinical manifestations and CT findings of traumatic pancreatitis, so as to improve its early diagnosis and treatment.Materials and Methods The clinical manifestations and CT images of 25 patients with traumatic pancreatitis confirmed by operation or post-treatment review were analyzed retrospectively. Pancreatic injuries were classified as superficial lesions (with the depth of trauma less than 50% of the thickness of pancreas) and deep lesions (with the depth of trauma more than 50% of the thickness of pancreas). The clinical manifestations, CT findings and the complicated organ injuries in these two types of pancreatic trauma were analyzed.Results Eight patients had superficial lesions, and 17 patients were with deep lesions. Nine patients had complicated organ injuries. Patients with deep lesions showed a more severe abdominal pain, nausea, vomiting, rebound tenderness and muscular tension than those patients with superficial lesions. The serum amylases increased in all the patients. Pancreatic-relevant complications including pancreas pseudocyst, pancreatic fluid leakage and peritonitis occurred in 7 patients who accepted a delayed operation. Three out of 8 patients with superficial pancreatic injuries were missed on plain CT scan in the first time. Among 17 patients with deep pancreatic trauma, 12 had incomplete laceration, 5 had complete laceration, and 1 was missed in the first time. The direct CT features of pancreatic trauma were focal abnormal attenuation and/or discontinuity in pancreatic parenchyma.Conclusion The clinical manifestations of patients with traumatic pancreatitis are complicated. The direct CT features of pancreatic trauma include heterogeneous density of pancreatic parenchyma and/or interruption. Trauma's depth is closely related to the main injury of pancreatic duct. It is worth to be aware of the indirect signs such as peripancreatic oozy and other viscera damages.