Ishikawa Kazuo, Idoguchi Koji, Tanaka Hiroshi, Tohma Yoshiki, Ukai Isao, Watanabe Hiroaki, Matsuoka Tetsuya, Yokota Jyunichiro, Sugimoto Tsuyoshi
Osaka Prefectural Senshu Critical Care Medical Center, 2-24 Rinku-Ourai-Kita, Izumisano-shi, Osaka 598-0048, Japan.
Eur J Radiol. 2006 Dec;60(3):445-52. doi: 10.1016/j.ejrad.2006.06.014. Epub 2006 Aug 7.
This study aimed to provide a classification system for acute pancreatitis by applying the principle that the disease spreads along the retroperitoneal interfascial planes.
Medical records and computed tomography (CT) images of 58 patients with acute pancreatitis treated between 2000 and 2005 were reviewed. The retroperitoneum was subdivided into 10 components according to the concept of interfascial planes. Severity of acute pancreatitis was graded according to retroperitoneal extension into these components. Clinical courses and outcomes were compared with the grades. The prognostic value of our classification system was compared with that of Balthazar's CT severity index (CTSI).
Retroperitoneal extension of acute fluid collection was classified into five grades: Grade I, fluid confined to the anterior pararenal space or retromesenteric plane (8 patients); Grade II, fluid spreading into the lateroconal or retrorenal plane (16 patients); Grade III, fluid spreading into the combined interfascial plane (8 patients); Grade IV, fluid spreading into the subfascial plane beyond the interfascial planes (15 patients); and Grade V, fluid intruding into the posterior pararenal space (11 patients). Morbidity and mortality were 92.3% and 38.5% in the 26 patients with Grade IV or V disease, and 21.9% and 0% in the 32 patients with Grade I, II, or III disease. Morbidity and mortality were 86.7% and 33.3% in patients with disease classified "severe" according to the CTSI, and 37.5% and 9.4% in patients with disease classified "mild" or "moderate".
Classification of acute pancreatitis based on CT-determined retroperitoneal extension is a useful indicator of the disease severity and prognosis without the need for contrast-medium enhanced CT.
本研究旨在通过应用疾病沿腹膜后间隙平面扩散的原理，为急性胰腺炎提供一种分类系统。
回顾了2000年至2005年间接受治疗的58例急性胰腺炎患者的病历和计算机断层扫描（CT）图像。根据间隙平面的概念，将腹膜后间隙分为10个部分。根据急性胰腺炎在这些部分的腹膜后扩展情况对其严重程度进行分级。将临床病程和结果与分级情况进行比较。将我们的分类系统的预后价值与巴尔萨泽CT严重指数（CTSI）的预后价值进行比较。
急性液体积聚的腹膜后扩展分为五个等级：I级，液体局限于肾前间隙或肠系膜后平面（8例患者）；II级，液体扩散至侧锥间隙或肾后间隙平面（16例患者）；III级，液体扩散至联合间隙平面（8例患者）；IV级，液体扩散至间隙平面以外的筋膜下平面（15例患者）；V级，液体侵入肾后间隙（11例患者）。IV级或V级疾病的26例患者的发病率和死亡率分别为92.3%和38.5%，I级、II级或III级疾病的32例患者的发病率和死亡率分别为21.9%和0%。根据CTSI分类为“重度”疾病的患者的发病率和死亡率分别为86.7%和33.3%，分类为“轻度”或“中度”疾病的患者的发病率和死亡率分别为37.5%和9.4%。
基于CT确定的腹膜后扩展对急性胰腺炎进行分类是疾病严重程度和预后的一个有用指标，无需进行对比剂增强CT检查。
