Fan S T, Choi T K, Chan F L, Lai E C, Wong J
Department of Surgery, University of Hong Kong.
J Gastroenterol Hepatol. 1990 Mar-Apr;5(2):103-9. doi: 10.1111/j.1440-1746.1990.tb01812.x.
The usefulness of computed tomography (CT) in guiding the management of 43 patients who had a complicated clinical course of acute pancreatitis was retrospectively studied. The CT scans were performed when patients had persistent fever, leucocytosis, hyperamylasaemia, palpable abdominal masses or when there was organ failure. The CT scans showed normal findings in six patients, features of pancreatic abscess in three patients, pseudocysts in three patients and inflammatory masses (a mixture of sterile inflammation and necrosis) in 31 patients. Patients with pancreatic abscesses underwent emergency laparotomy, drainage and debridement; patients with pseudocysts had delayed drainage unless complication occurred; patients with normal CT scan or findings of inflammatory masses were managed conservatively. For patients undergoing conservative management, repeated CT scanning and percutaneous aspiration of the inflammatory mass was performed when pancreatic sepsis was strongly suspected. By this approach, basing on careful clinical and CT scan surveillance, five patients with pancreatic sepsis (pancreatic abscess and localized abscess collection in pseudocyst) underwent emergency surgery and four survived, while 25 patients with inflammatory masses were successfully managed conservatively and some who may have been operated on clinical grounds were spared unnecessary early debridement surgery.
回顾性研究了计算机断层扫描（CT）在指导43例急性胰腺炎临床过程复杂患者治疗中的作用。当患者持续发热、白细胞增多、血淀粉酶升高、可触及腹部肿块或出现器官衰竭时，进行CT扫描。CT扫描显示6例患者结果正常，3例患者有胰腺脓肿特征，3例患者有假性囊肿，31例患者有炎性肿块（无菌性炎症和坏死的混合物）。胰腺脓肿患者接受急诊剖腹手术、引流和清创；假性囊肿患者除非发生并发症，否则延迟引流；CT扫描正常或有炎性肿块表现的患者采取保守治疗。对于接受保守治疗的患者，当强烈怀疑胰腺感染时，重复进行CT扫描并经皮穿刺抽吸炎性肿块。通过这种方法，基于仔细的临床和CT扫描监测，5例胰腺感染患者（胰腺脓肿和假性囊肿内局限性脓肿积聚）接受了急诊手术，4例存活，而25例有炎性肿块的患者成功接受了保守治疗，一些可能因临床原因接受手术的患者避免了不必要的早期清创手术。
