急性胰腺炎CT分级.docVIP

按照Balthazar分级标准，急性胰腺炎在CT上可分为五级。A级：胰腺边界清晰，胰周脂肪间隙存在，血尿淀粉酶均轻度升高；B级：胰腺头、体、尾部局限性肿大或胰腺体积弥漫性肿大（包括胰腺轮廓不规则，胰腺实质密度不均匀，胰内小灶性局限性积液和胰管扩张），胰腺周围脂肪间隙形态正常，血尿淀粉酶中度升高，；C级：胰腺实质形态及密度异常伴有胰腺周围脂肪炎性改变，无明显积液征象，血尿淀粉酶均明显升高，尿淀粉酶更显著；D级：胰腺周围多个间隙之一积液，血尿淀粉酶趋向下降；E级：胰腺周围多个间隙中2个或2个以上间隙积液，或胰腺实质内、胰腺周围脂肪间隙内气体影出现，胰腺实质或胰周脓肿形成，血尿淀粉酶下降明显。A~C级为临床诊断水肿型，无严重合并症发生，预后好，经治疗可痊愈或好转，属临床轻型胰腺炎。CT表现为D级和E级患者均为临床重型及出血坏死型胰腺炎，预后差。早期行CT检查得以确诊者，如早期及时治疗，均可痊愈出院。根据以上分级研究，A级急性胰腺炎，诊断主要依靠临床症状、体征、血尿淀粉酶变化等体液检查结果；急性胰腺炎B、C级CT 表现有较明确的特异性，亦可见血尿淀粉酶明显提高，此时临床诊断结合CT表现与血尿淀粉酶值改变对确诊具有重要意义；急性胰腺炎D级、E级患者胰腺出现了 局部坏死或脓肿形成，血尿淀粉酶由显著升高到明显下降，尿淀粉酶更为显著，这一变化提示胰腺炎症致胰腺腺体破坏过多，胰酶的分泌功能明显下降，提示病情恶 化。对于胰腺外液体贮留、胰腺坏死或合并脓肿的病例，那是高危病例，病死率高。胰腺脓肿CT诊断可显示胰腺脓肿的有无、大小、数目和位置。主要诊断依据是 胰腺及胰周积液中是否有气泡出现，但气泡的检出率较低。Bahhazar提出在发病2-4周后CT扫描图像上仍可见边界不清的局限性积液的患者应高度怀疑 脓肿形成。 按照上边的分级标准，本例考虑B级。 County economic work conference leadership speech:The main task of the twenty-six session of the six plenary meeting of the county the county economic work conference this time, by the partys eighteen and eighteen Third Plenary Session of the spirit as a guide, carry out and implement the central and provincial economic work conference on rural work conference and the three session of the seven plenary session of the party to expand the spirit of the meeting, the total summary of last year the work, analysis of the current situation, the deployment of this work, further strengthening the development of consensus, to mobilize the whole county county, deepening reform and innovation, to work against poverty, accelerate the transformation of leapfrog, promote scientific development, struggling to write a new harmonious beautiful mountains and show a prosperous civilization to build a new building. The following chapter * *, according to the county Discussion of the views of the Standing Committee, I focus on four aspects of the problem:* * * years, the county to seriously implement the central decision-making arrangements and real, in accordance with the high position, as a typical tree