急性胰腺炎的临床处理.ppt

华西医院中西医结合科;1CenterforPancreaticCare,SouthernCaliforniaPermanenteMedicalGroup,DepartmentofGastroenterology,KaiserPermanenteLosAngelesMedicalCenter,LosAngeles,California（南加州,凯萨医疗机构）;and2CenterforPancreaticDisease,DivisionofGastroenterology,HepatologyandEndoscopy,BrighamandWomen’sHospital,HarvardMedicalSchool,Boston,Massachusetts（波士顿，哈佛医学院);Abstract;Contents;Diagnosis;;;;;间质水肿性胰腺炎;;Figure2.Pancreaticandperipancreaticnecrosis.Thisimageshowsanacutenecroticcollectioninvolvingboththepancreas(largearrow)andperipancreatictissue.

Figure3.Walled-offpancreaticnecrosisisanencapsulatedcollectionofnecrosis.Thistypeofcollectiontypicallyforms4to6weeksafterdiseaseonset.Thisimageshowspancreaticandperipancreaticnecrosis.;De?nitionofSystemicComplicationsandOrganFailure;De?nitionofSystemicComplicationsandOrganFailure;De?nitionofSeverity;Mostpatientswithmildacutepancreatitisdonotrequirepancreaticimaginganalysisandareusuallydischargedwithin3to5daysofonsetofillness.

轻型急性胰腺炎患者无需影像学检查，住院时间通常为3-5天;RolesofAdvancedImagingTechniques;;MRCPhasbecomeausefulprocedureforidentifyingretainedcommonbileductstones.SelectiveuseofMRCPcanreducetheneedforERCPforpatientswithsuspectedgallstonepancreatitis.

MRCP对胆管结石敏感，能够减少因怀疑为胆源性胰腺炎而行ERCP检查。

MRIishelpfulindistinguishingwalled-offnecrosisfromapseudocyst.Forexample,inwalled-offnecrosis,therearevariableamountsof?uidandsoliddebristhatcanbevisualizedusingT2-weightedimaging.

MRI能用于鉴别是包裹性坏死（WON）或是胰腺假性囊肿，因为T2加权像能很直观地看出含有大量渗液体及固体坏死物的包裹性坏死。

Endoscopicultrasonographyisahighlysensitivetestfordetectingcholelithiasisandcholedocholithiasis.19ItcouldbeanalternativetoMRCP,whichhaslimitedaccuracyfordetectingsmallergallstonesorsludge.

超声内镜对胆石病高度敏感，可以代替对细小结石或淤泥样胆汁不敏感的MRCP检查。

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