Balthazar E J, Robinson D L, Megibow A J, Ranson J H
Department of Radiology, New York University Medical Center, NY 10016.
Radiology. 1990 Feb;174(2):331-6. doi: 10.1148/radiology.174.2.2296641.
The presence and degree of pancreatic necrosis (30%, 50%, or greater than 50%) was evaluated by means of bolus injection of contrast material and dynamic sequential computed tomography (CT) in 88 patients with acute pancreatitis at initial and follow-up examinations. Pancreatic necrosis was defined as lack of enhancement of all or a portion of the gland. Length of hospitalization, morbidity, and mortality in patients with early or late necrosis (22 patients) were evaluated and compared with the same criteria in the rest of the group. Patients with necrosis had a 23% mortality and an 82% complication rate; patients without necrosis had 0% mortality and 6% morbidity. When only the initial assessment was considered, patients with peripancreatic phlegmons and necrosis had 80% morbidity, compared with 36% morbidity in those with phlegmons and no necrosis. Serious complications occurred in patients who initially had or developed more than 30% necrosis. A CT severity index, based on a combination of peripancreatic inflammation, phlegmon, and degree of pancreatic necrosis as seen at initial CT study, was developed. Patients with a high CT severity index had 92% morbidity and 17% mortality; patients with a low CT severity index had 2% morbidity, and none died.
通过对88例急性胰腺炎患者在初始检查和随访检查时静脉注射造影剂并进行动态序列计算机断层扫描（CT），评估胰腺坏死的存在情况及程度（30%、50%或大于50%）。胰腺坏死定义为胰腺全部或部分无强化。对早期或晚期坏死患者（22例）的住院时间、发病率和死亡率进行评估，并与其余患者组采用相同标准进行比较。坏死患者的死亡率为23%，并发症发生率为82%；无坏死患者的死亡率为0%，发病率为6%。仅考虑初始评估时，胰腺周围有脓肿和坏死的患者发病率为80%，而有脓肿但无坏死的患者发病率为36%。最初有或发展为坏死超过30%的患者发生严重并发症。基于初始CT检查所见的胰腺周围炎症、脓肿及胰腺坏死程度，制定了CT严重指数。CT严重指数高的患者发病率为92%，死亡率为17%；CT严重指数低的患者发病率为2%，无死亡病例。
