感染坏死性胰腺炎在CT影像学上的临床分型  

Clinical classification of infected necrotizing pancreatitis on CT imaging

作　　者：涂玉亮[1] 蔡守旺[1] 刘志伟[1] 王大东[1] 谭向龙[1] 宦宏波 冯健[1] 辛先磊 王鹏飞[1] 韩明明 张卓超 TU Yu-liang;CAI Shou-wang;LIU Zhi-wei;WANG Da-dong;TAN Xiang-long;HUAN Hong-bo;FENG Jian;XIN Xian-lei;WANG Peng-fei;HAN Ming-ming;ZHANG Zhuo-chao(Faculty of Hepato-Pancreato-Biliary Surgery,Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院肝胆胰外科医学部,北京100048

出　　处：《肝胆胰外科杂志》2021年第6期325-330,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：国家自然科学基金项目(81802958)。

摘　　要：目的总结分析感染坏死性胰腺炎(infected necrotizing pancreatitis,INP)感染坏死灶在CT影像学上的解剖学位置与分布特点,并据此对INP进行临床分型,为INP的外科处理提供参考。方法选取解放军总医院第一医学中心和第四医学中心2008年6月6日至2014年12月31日INP病例112例,根据INP感染坏死灶CT影像学中位置分为五个区域:胰腺区域、网膜囊区、脾胃间隙区、左侧腹膜后间隙区、右侧腹膜后间隙区;据此分为三型:I型,感染灶位于胰腺区域,局限于胰腺实质组织、胰腺包膜周围脂肪组织、胰腺下沿肠系膜根部脂肪组织。II型,感染灶扩散至胰腺周围,包括网膜囊和脾胃间隙,IIa型感染灶扩散至网膜囊,IIb型感染灶扩散至脾胃间隙,IIc型感染灶同时存在于网膜囊和脾胃间隙。III型,感染灶扩散至侧腹膜后间隙,IIIa型感染灶扩散至左侧腹膜后间隙,IIIb型感染灶扩散至右侧腹膜后间隙,IIIc型感染灶扩散至左、右侧腹膜后间隙。结果112例INP患者共204个感染灶分别位于胰腺区域42个、网膜囊区43个、脾胃间隙区16个、左侧腹膜后间隙区68个、右侧腹膜后间隙区35个。I型12例(10.7%);II型14例(12.5%),其中IIa型8例,IIb型5例,IIc型1例;III型86例(76.8%),其中IIIa型51例,IIIb型17例,IIIc型18例。结论INP感染灶沿着胰周间隙,尤其是腹膜后间隙有着特征性扩散分布,根据该特征进行的INP分型,对INP治疗方案的选择和操作步骤的优化有指导作用。Objective To investigate the anatomical location and distribution characteristics of infected necrotizing pancreatitis(INP)on computed tomography(CT)imaging,and according to this,to make clinical classification of INP,and provide reference for the surgical treatment of INP.Methods 112 patients with INP in the First Medical Center and the Fourth Medical Center of PLA General Hospital from Jun.2008 to Dec.2014 were enrolled.CT imagings were checked and the locations of abscess were analyzed.The abscesses were mainly located on five regions,including pancreas region,omental bursa,gap of stomach and spleen,left lateral retroperitoneal space and right lateral retroperitoneal space.According to the spread range of abscess,INP was classified into 3 types.Type I,located on the pancreas region,confined to pancreatic parenchyma,peri capsular adipose tissue and inferior pancreas along mesenteric root.Type II,spreaded to omental bursa and gap of stomach and spleen,including type IIa,spreaded to omental bursa,type IIb,spreaded to gap of stomach and spleen,and type IIc,spreaded to omental bursa and gap of stomach and spleen.Type III,spreaded to lateral retroperitoneal space,including type IIIa,spreaded to left lateral retroperitoneal space,type IIIb,spreaded to right lateral retroperitoneal space,and type IIIc,spreaded to bilateral retroperitoneal space.Results There were totally 204 infected locations for the 112 patients,and one patient may have multiple abscesses:42 in the pancreas space,43 in the omental sac,16 in the splenogastric space,68 in the left retroperitoneal space,and 35 in the right retroperitoneal space.The classification was as follows:12 patients(10.7%)with type I INP,14 patients(12.5%)with type II(8 patients with type IIa,5 patients with type IIb,and 1 patient with type IIc),and 86 patients(76.8%)with type III(51 patients with type IIIa,17 patients with type IIIb,and 18 patients with type IIIc).Conclusion The distributions of INP infection along the peripancreatic space,especially along the retroperitoneal s

关 键 词：坏死性胰腺炎 感染性坏死 脓肿位置 CT影像 临床分型 

分 类 号：R657.51[医药卫生—外科学]