【摘要】 目的探讨腹部闭合性外伤所致胰腺断裂的CT表现特征。方法回顾性分析6例经手术证实的闭合性腹部外伤性胰腺断裂患者的临床与CT检查资料。常规腹部CT平扫后,再行胰腺动脉期、胰腺期与延迟期三期动态增强扫描,运用多平面重组(MPR)与最大密度投影(MIP)等后处理方法,强调薄层CT扫描及图像后处理技术。结果胰颈断裂2例,胰尾断裂2例,胰头、体断裂各1例。主要CT表现:(1)胰腺血肿6例,血肿位于胰内或胰内外,平扫为高密度或稍高密度,三期动态增强均无强化。(2)胰腺裂口6例,裂口呈裂隙状、楔形或完全离断分离。动态增强后尤其在胰腺实质期,胰腺显著强化而裂口内血肿不强化,呈相对低密度,清晰地勾画出胰腺裂口。(3)对比剂外溢2例,增强动脉期在胰腺断裂处的血肿内开始出现点状、结节状很高密度的对比剂影;胰腺期范围扩大,呈池状,其密度与同层的腹主动脉的密度相似;延迟期其范围进一步扩大,但此时腹主动脉密度已显著下降,而血肿内溢出的对比剂仍呈高密度。(4)断裂远端主胰管扩张1例,呈扭曲扩张的低密度管状。(5)合并肝、脾、肾等多脏器挫裂伤4例。结论胰腺断裂伤具有特征性CT表现;采用合理的扫描技术,并正确认识胰腺断裂的CT征象,有助于提高诊断准确率。更多还原

【Abstract】 Objective To study CT characteristic findings of pancreatic rupture caused by closed abdominal trauma.Methods The clinical and CT data of 6 patients with pancreatic rupture caused by closed abdominal trauma were analyzed retrospectively.CT plain scan and the tripple-phased enhancement scan were performed,multi-planar reformation(MPR)and maximum intensity projection(MIP)were used after CT scanning.Thin slice of CT scan and post-processing technique of imaging were used furthermore.Results The rupture of pancreatic neck and tail were shown in 2 cases,the rupture of pancreatic head and body in 1 case.Main CT findings were such as following:(1)Hematomas in pancreas or in pancreatic surrounding tissues were shown in 6 cases,they were hyperintensity or slight hyperintensity in plain scan and were not enhanced in three-phase dynamic scan of pancreas.(2)Pancreatic splits,which were relative hypointensity after administration of CT contrast agent in the pancreatic phase,were found in 6 cases,they were like slit-shaped or wedge-shaped or pancreas separated completely in situs.In the pancreatic phase,pancreas parenchyma enhanced obviously but hematoma in the splits did not enhanced,and this drew the outline of pancreatic splits clearly.(3)Contrast agent in the pancreatic hematomas,which leaked from vessels of pancreas,were shown in two patients,like dot or nodule or pond,were highly intensity in artery phase,and there were more leaking of contrast agent in the pancreatic phase,whose intensity was same as abdominal aorta in the same slice image.In the delayed phase,the volume of leaking contrast agent enlarged and they had higher intensity while intensity of abdominal aorta in same slice image decreased obviously.(4)Dilation of the Wirsung duct,which was like curved-tube,was shown in one patient.(5)Meanwhile the contusion of liver,kidney or spleen with pancreatic rupture were found in 4 patients.Conclusion The pancreatic rupture has typical CT findings.It is helpful to improve the accuracy rate of diagnosis with reasonable scanning techniques and understanding correctly CT appearances of pancreatic rupture.更多还原