包裹性坏死性胰腺炎

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坏死性胰腺炎或胰腺坏死是急性胰腺炎中最严重的一种，死亡率很高。最适合诊断急性胰腺炎的时期是从疾病症状开始的3—5天。在此期间，胰腺水肿和暂时性缺血可能伪装为坏死，并在后续研究中消失，反之亦然，局部并发症可能在没有临床相关性的情况下发生。

目前，在急性胰腺炎的治疗中，放射诊断方法越来越受到重视，尤其是计算机断层扫描，因为它可以更精确地测量胰腺容积、评估病情和测量脾静脉直径，这在未来可能对胰腺坏死过程的预后形成有重要影响。

这篇文章介绍了一个罕见的急性胰腺炎并发症的临床病例包裹性坏死性胰腺炎，它是在消化系统疾病的背景下出现的。本文介绍了放射诊断方法在这些病理学动态检查中的符号学方面。该病例值得注意的是，患者入院时的疾病表现与典型水肿型急性胰腺炎相当。在急性胰腺炎病程的临床和形态学阶段之间以及在胰腺坏死形成之前进行的一系列动态CT图像显示负动态进一步增加，并伴有胰腺体分离和胰旁脓肿形成，这使得最清楚地显示疾病的逐步发展成为可能。治疗模式发生了改变，保守治疗被积极的手术策略所取代，随后是反复操作、动态计算机断层扫描和磁共振控制，直到患者病情好转。

迄今为止，放射诊断方法结合适当的治疗和手术方法可以改善坏死性胰腺炎的预后。

作者简介

Svetlana I. Kitavina

Therapy and Rehabilitation Center

Email: skitavina@yandex.ru
ORCID iD: 0000-0002-1280-1089
SPIN 代码: 9741-1675

MD, Cand. Sci. (Med.)

俄罗斯联邦, 3 Ivan’kovskoe shosse, 125367, Moscow

Victor S. Petrovichev

Therapy and Rehabilitation Center

Email: petrovi4ev@gmail.com
ORCID iD: 0000-0002-8391-2771
SPIN 代码: 7730-7420

MD, Cand. Sci. (Med.)

俄罗斯联邦, 3 Ivan’kovskoe shosse, 125367, Moscow

Aleksandr N. Ermakov

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Email: alx-ermakovv@yandex.ru
ORCID iD: 0000-0003-0675-8624
SPIN 代码: 9257-9319

MD

俄罗斯联邦, 3 Ivan’kovskoe shosse, 125367, Moscow

Nikolay A. Ermakov

Therapy and Rehabilitation Center

Email: n-ermakov@yandex.ru
ORCID iD: 0000-0002-1271-7960
SPIN 代码: 5985-9032

MD, Cand. Sci. (Med.)

俄罗斯联邦, 3 Ivan’kovskoe shosse, 125367, Moscow

Igor G. Nikitin

Therapy and Rehabilitation Center

编辑信件的主要联系方式.
Email: igor.nikitin.64@mail.ru
ORCID iD: 0000-0003-1699-0881
SPIN 代码: 3595-1990

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, 3 Ivan’kovskoe shosse, 125367, Moscow

参考

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1. JATS XML
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2. 图 1静脉注射造影剂的腹部计算机断层扫描：胰腺周围脂肪组织的浸润和肝脏下间隙的脂肪组织（箭头）。

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3. 图 2静脉注射造影剂的腹部计算机断层扫描：胰腺周围脂肪组织、左侧肾周围筋膜、胰头和胰体实质的浸润和液体积聚（箭头）。

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4. 图 3静脉注射造影剂的腹部计算机断层扫描：胰腺周围脂肪组织、左侧肾周围筋膜、胰头和胰体实质（箭头）的浸润和液体积聚；引流管（左侧图像中的人字形箭头）。在反复的分析中，注意到沿着渗透带形成了一层薄薄的对比囊。

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5. 图 4腹腔器官CT与静脉造影：胰腺周围脂肪组织的引流浸润和液体积聚，在复查中减少（左图，箭头），引流内容物的腔内有止血海绵；引流管（右图，人字形箭头）。在重复分析中，注意到沿着浸润区的路线进一步形成了一个薄的、对比强烈的囊状物。

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6. 图 5磁共振成像胆道造影（左图）和 T٢-WI（冠状面，右图）。胆总管的远端部分在浸润中消失，胆总管的近端部分和肝内胆管没有淤塞（箭头）。

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7. 图 6静脉注射造影剂的腹部计算机断层扫描：引流管（左图，箭头）；引流管浸润和胰腺周围脂肪组织中的液体积聚，随时间推移而减少（右图，箭头）。

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