Lee M J, Wittich G R, Mueller P R
Department of Radiology, Beaumont Hospital, Dublin Ireland.
Radiographics. 1998 May-Jun;18(3):711-24; discussion 728. doi: 10.1148/radiographics.18.3.9599393.
Interventional radiology has an important role to play in the management of local complications of acute pancreatitis, such as necrosis, pseudocyst, and abscess. Computed tomography (CT) is preferred for guiding pancreatic interventional procedures, with the most common access routes being through the left anterior pararenal space for pancreatic tail collections and through the gastrocolic ligament for pancreatic head and body collections. Pancreatic necrosis has a high mortality if infected, and the presence of infection must be determined with CT-guided needle aspiration. Careful planning of the access route is important to avoid the colon. Catheters of 8-12 F are usually sufficient for pseudocyst drainage. An average of 2-3 weeks drainage is required if there is no communication of the pseudocyst with the pancreatic duct and many weeks to months for pseudocysts with pancreatic duct communication. Percutaneous drainage of pseudocysts is associated with success rates of 80%-90%. Pancreatic abscess drainage has quoted success rates varying between 32% (infected necrosis) and 90% (pancreatic abscess). Use of large or multiple catheters is often required for complete drainage. The management of patients with severe acute pancreatitis is time-consuming and labor intensive for interventional radiologists, and a team approach with close communication with surgical personnel is required.
介入放射学在急性胰腺炎局部并发症（如坏死、假性囊肿和脓肿）的管理中发挥着重要作用。计算机断层扫描（CT）是引导胰腺介入操作的首选方法，最常见的穿刺路径是经左肾前间隙穿刺引流胰尾病变，经胃结肠韧带穿刺引流胰头和胰体病变。胰腺坏死若发生感染则死亡率很高，必须通过CT引导下的穿刺抽吸来确定是否存在感染。仔细规划穿刺路径对于避免损伤结肠很重要。8-12F的导管通常足以用于假性囊肿引流。如果假性囊肿与胰管不连通，平均需要引流2-3周；如果假性囊肿与胰管连通，则需要引流数周乃至数月。经皮穿刺引流假性囊肿的成功率为80%-90%。胰腺脓肿引流的成功率据报道在32%（感染性坏死）至90%（胰腺脓肿）之间。通常需要使用大口径或多个导管才能完全引流。对于介入放射科医生来说，重症急性胰腺炎患者的管理既耗时又费力，需要采取团队协作方式并与外科人员密切沟通。
