Leone A, Violino P, Ghirardo D, Fioranti L, Borrelli M, Scarrone A, Pancione L, Ambrogi C, Ferro C
Servizio di Radiodiagnostica, Ospedale S. Crooc, Cuneo.
Radiol Med. 1996 Sep;92(3):241-6.
In the last few years, Computed Tomography (CT) has emerged as the most sensitive and reliable imaging technique to diagnose acute pancreatitis (AP). Besides assessing the extent of damage to the pancreas and to periglandular tissue. CT can recognize the major early and late complications of the disease promptly and with extreme accuracy. We investigated the diagnostic capabilities of CT in controlling AP development and tried to assess the role of interventional radiology as a therapeutic support after or instead of surgery in treating the necrotic forms of pancreatitis complicated by sepsis. From 1989 to 1995, acute pancreatitis mostly due to biliary tract disease and alcoholism was diagnosed in 228 patients. Necrotic processes were identified in 105 of them since disease onset; septic complications developed in 57 patients. Surgery was performed in 42 patients, but the result was poor in 11 of them (30%) and CT showed the persistence of some infectious pancreatic exudate which had been drained insufficiently. Since sepsis persisted in these patients, the exudate was aspirated percutaneously after positioning appropriate drainage means guided by abdominal CT. Sepsis resolved completely in 10 patients, while one required subsequent surgery. Percutaneous drainage catheters were positioned in 15 patients as the treatment of choice, under CT and US guidance. Sepsis resolved in 7 cases only (45%), while 3 of the extant patients died and 5 needed surgery. The results of our experience demonstrate the effectiveness of percutaneous drainage under CT guidance. However, this technique should be used after and as a support to surgery, the latter remaining the treatment of choice for infectious necrotic AP. Thus, in our experience, the use of percutaneous aspiration instead of surgery proved to be a less effective tool in curing this condition and its use should therefore be limited to high-risk surgical patients.
在过去几年中，计算机断层扫描（CT）已成为诊断急性胰腺炎（AP）最敏感、最可靠的成像技术。除了评估胰腺和腺周组织的损伤程度外，CT还能迅速且极其准确地识别该疾病的主要早期和晚期并发症。我们研究了CT在监测AP病情发展方面的诊断能力，并试图评估介入放射学在治疗并发脓毒症的坏死性胰腺炎时作为手术替代或术后治疗支持手段的作用。1989年至1995年期间，228例主要由胆道疾病和酗酒引起的急性胰腺炎患者被确诊。其中105例自发病起即出现坏死过程；57例出现脓毒症并发症。42例患者接受了手术，但其中11例（30%）效果不佳，CT显示一些感染性胰腺渗出物持续存在，引流不充分。由于这些患者的脓毒症持续存在，在腹部CT引导下放置合适的引流装置后，经皮抽吸渗出物。10例患者的脓毒症完全消退，1例随后需要手术。在CT和超声引导下，15例患者选择经皮放置引流导管进行治疗。仅7例（45%）脓毒症消退，其余3例患者死亡，5例需要手术。我们的经验结果证明了CT引导下经皮引流的有效性。然而，该技术应在手术后使用并作为手术的支持手段，手术仍是感染性坏死性AP的首选治疗方法。因此，根据我们的经验，经皮抽吸替代手术在治愈这种疾病方面被证明是一种效果较差的手段，因此其应用应仅限于高风险手术患者。
