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目的 分析重症急性胰腺炎 (SAP)的胸部X线及CT表现 ,探讨SAP并发急性肺组织损伤的机理及联系 ,提高其对SAP临床诊断和预后价值的认识。方法 对临床及胰腺CT诊断的 39例SAP行X线胸片检查 ,其中 11例加做胸部CT ,所有病例均有3次以上的X线胸片复查。男 17例 ,女 2 2例 ,年龄 2 6～ 6 4岁。结果 在胰腺CT诊断SAP时显示腹水 34例 ,同时胸片及胸部CT出现肺水肿征象者 16例 ( 4 1% ) ,2 4h内出现者 2 4例 ( 6 1.5 % ) ,48h内出现者 37例 ( 94.9% ) ,72h内均出现上述征象。共出现胸水 19例。 16例最早出现肺水肿征象者中 11例有胸水 ,1例合并心包积液 ,10例发展为成人呼吸窘迫综合征 (ARDS) ,死亡 7例。结论 SAP的胸部影像表现对提示ARDS的早期诊断和预后有重要意义 ,亦可作为判断SAP病变严重程度的临床指标之一。
Objective To analyze the chest X-ray and CT findings of severe acute pancreatitis (SAP) and to explore the mechanism and relationship of SAP complicated with acute lung injury and to improve their understanding of clinical diagnosis and prognosis of SAP. Methods Thirty-nine cases of SAP diagnosed by clinical and pancreatic CT were examined by X-ray. Eleven cases were examined by chest CT, and all cases were examined by X-ray three times or more. There were 17 males and 22 females, aged 26 to 64 years old. Results In the diagnosis of SAP with pancreatic CT, 34 patients showed ascites, while 16 cases (41%) showed signs of pulmonary edema on chest X-ray and chest CT, 24 cases (21.5%) occurred within 24 hours, 37 Cases (94.9%), 72h appear above signs. A total of 19 cases of pleural effusion. Of the 16 patients with signs of pulmonary edema, 11 had pleural effusion, 1 had pericardial effusion, 10 developed ARDS, and 7 died. Conclusion The chest imaging of SAP is of great significance to the early diagnosis and prognosis of ARDS. It may also be used as one of the clinical indexes to judge the severity of SAP.