急性胰腺炎不同时期并发急性无结石性胆囊炎超声特点分析  

Ultrasonic features of acute acalculous cholecystitis developing at different stages of acute pancreatitis

作　　者：李百强[1] 李刚[1] 叶博[1] 柯路[1] 童智慧[1] 孟庆欣[2] 李维勤[1] 黎介寿 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)全军普通外科研究所,南京医学博士210002 [2]南京大学医学院附属金陵医院(南京军区南京总医院)超声诊断科,南京210002

出　　处：《医学研究生学报》2017年第1期61-65,共5页Journal of Medical Postgraduates

基　　金：江苏省社会发展项目(BE2015685)

摘　　要：目的急性胰腺炎在不同病程时期机体免疫-炎症-营养状况不同,并发急性无结石性胆囊炎(AAC)所表现的临床及超声影像特点也不尽相同,目前相关研究很少。文中旨在分析总结急性胰腺炎不同病程时期并发AAC超声检查特点。方法回顾性分析南京军区南京总医院2013年1月至2015年12月确诊急性胰腺炎并发AAC 41例患者的临床资料,以并发AAC时间是否在急性胰腺炎发病2周内作为时间节点分为早期组(发病时间≤2周,n=18)与中后期组(发病时间>2周,n=23),记录并分析2组患者超声下:胆囊大小、胆囊壁厚度、胆囊窝积液、胆泥淤积以及超声Murphy氏征情况;检测AAC相关的临床及实验室指标:体温、Murphy氏征、白细胞计数、C反应蛋白等。总结急性胰腺炎不同病程时期并发AAC的超声检查特点。结果全部患者均有不同程度发热,体温均超过38.5℃;早期组、中后期组患者伴有寒颤者分别占38.89%和47.83%,WBC升高者分别占94.44%、82.61%,C反应蛋白升高者分别占100%、91.30%。早期组的胆囊窝积液发生率较中后期组升高(94.44%vs 60.86%,P<0.05),胆囊壁增厚发生率降低(11.11%vs 78.26%,P<0.01)。结论 AP患者在不同时期并发AAC具有不同的超声特点,病程早期更容易出现胆囊窝积液,中后期更容易出现胆囊壁增厚。Objective Acute pancreatitis exhibits different clinical and ultrasonic features in patients complicated with acute acalculous cholecystitis（ AAC） at different stages. The aim of this study was to analyze the ultrasonic characteristics of acute pancreatitis complicated with AAC at different stages. Methods We retrospectively analyzed the clinical data about 41 cases of acute pancreatitis with moderate to severe AAC. According to whether AAC developed within or after 2 weeks of the onset of acute pancreatitis,we divided the patients into an early-stage group（ n = 18） and a late-stage group（ n = 23）. We recorded the gallbladder size,gallbladder wall thickness,fluid around the gallbladder,biliary sludge deposition and the Murphy＇s sign by ultrasonography,obtained AAC-related clinical and laboratory data concerning body temperature,Murphy＇ s sign,WBC count and C-reactive protein level, and analyzed the ultrasonic features of AAC at different stages in the acute pancreatitis patients. Results All the patients experienced a fever of 〉38.5 ℃,38.89% with chills in the early onset group and 47. 83% in the late onset group. Increases were observed in patients of the early- and late-stage groups in the WBC count（ 94.44% vs 82.61%）,the C-reactive protein level（ 100% vs 91.30%）,and the fluid volume around the gallbladder（ 94.44% vs 60.86%,P〈0.05）,but incidence rate of gallbladder wall thickening was significantly lower in the former than in the latter group（ 11.11% vs 78.26%,P〈0.01）. Conclusion AAC developing at different stages of acute pancreatitis has different ultrasonic features,with higher incidence rates of fluid around the gallbladder in the early stage and gallbladder wall thickening in the late stage.

关 键 词：急性胰腺炎 急性无结石性胆囊炎 超声 

分 类 号：R576[医药卫生—消化系统]