急性的胰腺炎亚特兰大分类标准修订.ppt

急性胰腺炎的亚特兰大分类标准修订：对影像科医师和临床医师具有重大指导意义;概况;概况;论述了急性胰腺炎的临床病程和严重性 将AP分成间质水肿性胰腺炎（interstitial edematous pancreatitis, IEP）和坏死 性胰腺炎（necrotizing pancreatitis） 区分了早期（1周）和晚期（1周后） 强调了全身炎症反应综合征（SIRS）和多系统器官功能衰竭（MOF） 重症AP是指在早期（1周）持续出现器官衰竭（超过48小时）或死亡;晚期出现持续器官衰竭、死亡或AP引起并发症 在发病第1周，临床参数是制定治疗计划的唯一重要依据。1周后，以临床参数结合CT为基础的形态学标准制定治疗方案;新的胰腺液体积聚术语;Revised Atlanta classification of fluid collections in acute pancreatitis;临床定义;病程和疾病严重程度; Marshall评分系统-评估OF最常用方法;;第二阶段（后期-发病1周以后):特点是坏死、感染、持续的MOF发生率增加 治疗的方式取决于增强CT或MRI上胰腺和胰周的影像学表现和并发症表现 胰腺坏死范围增大、持续SIRS和MOF的死亡率明显升高，无菌性坏死的死亡率相对较低（5％-10％） 有一个正在进行讨论的第三类型称为“中度急性胰腺炎”，它包括患者有胰腺或胰周无菌性并发症或短暂的OF，但没有持久的全身并发症;急性胰腺炎的形态学分级;间质水肿性胰腺炎（IEP）;39岁男性，起病48小时。在胰体和颈部（箭头）有低密度区，但不能判断IEP或片状坏死，只能判断为性质待定。后来患者多次复查CT并没有发现任何坏死;急性坏死性胰腺炎;Figure 5: Acute necrotizing pancreatitis: pancreatic parenchymal necrosis alone. (a) Axial CT image in a 38-year-old man obtained 5 days after onset of symptoms. Tail and body of the pancreas are nonenhancing(arrows) and slightly heterogeneous in appearance. (b) On coronal reformation CT image obtained 4 weeks after onset, capsule (arrows) is evident and some heterogeneity (arrowheads) is seen within this collection, reflecting presence of nonliquefied material.;急性坏死性胰腺炎;peripancreatic necrosis alone;急性坏死性胰腺炎;Parenchymal necrosis in tail of the pancreas with ANCs in a 34-year-old man. Axial CT image shows necrosis (arrowheads) in tail of the pancreas as lack of enhancement. Multiple ANCs (arrows) are seen surrounding tail and body of the pancreas;胰腺及胰周液体积聚;;Figure 8: IEP in a 25-year-old woman with alcohol abuse and epigastric pain for 72 hours. Axial CT image shows the pancreas (arrowhead) to be slightly edematous and heterogeneously enhancing. APFCs (arrows) are seen surrounding the pancreas.;假性囊肿;Figure 9: Pancreatitis with pseudocyst in a 27-year-old woman. Coronal CT reconstruction obtained 5 weeks after acute episode shows pseudocyst (arrows) with well-defined rim reprsenting the capsule near the tail of the pancreas. Gastric f