胰腺炎脾血管并发症的解剖与诊断进展_West China Medical Journal

Authors：

 蔡迪明 ¹ ,  宋彬 ²

1. ;
2. ;

Corresponding author：

宋彬, Email: cjr.songbin@vip.163.com

Keywords：

胰腺炎脾脏并发症; 胰腺炎脾动脉并发症; 胰腺炎脾静脉并发症; 超声; 增强CT

DOI：

10.7507/1002-0179.20150616

Video：

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Abstract Full text Figures/Tables Video References Cited by

胰腺炎脾血管并发症是较为常见的胰腺炎血管并发症，其发生率虽不高，却是胰腺炎病情重危程度、预后不良的征象之一，如脾动脉假性动脉瘤破裂可危及患者的生命。因此对于胰腺炎脾血管并发症的准确诊断就显得特别重要。超声作为急性胰腺炎检查中最常用的手段，由于易受胃肠道麻痹致腹内胀气、腹膜后血管彩色血流衰减、检查者经验和手法等原因的影响，导致超声对于胰腺炎脾血管并发症的诊断准确率较低。现通过文献复习，对该病的发生、发展以及诊断的进展进行综述，以提高超声医师对该疾病的认识，提高诊断的准确性。

Citation： 蔡迪明, 宋彬. 胰腺炎脾血管并发症的解剖与诊断进展. West China Medical Journal, 2015, 30(11): 2171-2174. doi: 10.7507/1002-0179.20150616 Copy

1.	Mallory TB. Pathology[J]. N Engl J Med, 1947, 236(12):438-443.
2.	Fishman EK, Soyer P, Bliss DF, et al. Splenic involvement in pancreatitis:spectrum of CT findings[J]. AJR Am J Roentgenol, 1995, 164(3):631-635.
3.	武先聪. 急性胰腺炎及其并发症超声现象探讨[J]. 检验医学与临床, 2011, 8(11):1326-1327.
4.	Caslowitz PL, Labs JD, Fishman EK, et al. Nontraumatic focal lesions of the spleen:assessment of imaging and clinical evaluation[J]. Comput Med Imaging Graph, 1990, 14(2):133-141.
5.	Malka D, Hammel P, Lévy P, et al. Splenic complications in chronic pancreatitis:prevalence and risk factors in a medical-surgical series of 500 patients[J]. Br J Surg, 1998, 85(12):1645-1649.
6.	Mortele KJ, Mergo PJ, Taylor HM, et al. Splenic and perisplenic involvement in acute pancreatitis:determination of prevalence and morphologic helical CT features[J]. J Comput Assist Tomogr, 2001, 25(1):50-54.
7.	中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会, 中华消化杂志编辑委员会. 中国急性胰腺炎诊治指南(2013年, 上海)[J]. 中华消化杂志, 2013, 33(4):217-222.
8.	Carr SC, Mahvi DM, Hoch JR, et al. Visceral artery aneurysm rupture[J]. J Vasc Surg, 2001, 33(4):806-811.
9.	Rypens F, Devière J, Zalcman M, et al. Splenic parenchymal complications of pancreatitis:CT findings and natural history[J]. J Comput Assist Tomogr, 1997, 21(1):89-93.
10.	刘树伟, 王怀经, 柳澄, 等. 右肺门支气管和血管在横断面上的配布特点[J]. 中国临床解剖学杂志, 2004, 22(5):457-462.
11.	Wang L, Liu GJ, Chen YX, et al. Sinistral portal hypertension:clinical features and surgical treatment of chronic splenic vein occlusion[J]. Med Princ Pract, 2011, 21(1):20-23.
12.	Sawlani V, Phadke RV, Baijal SS, et al. Arterial complications of pancreatitis and their radiological management[J]. Australas Radiol, 1996, 40(4):381-386.
13.	游箭, 钟立明, 胡鸿, 等. 重症急性胰腺炎并发大出血的血管造影和栓塞治疗[J]. 当代医学, 2009, 3(5):18-20.
14.	杜章, 吴昊, 吴伟林, 等. 不同严重程度急性胰腺炎大鼠IL-17、IL-23的表达及其相关性[J]. 肝胆胰外科杂志, 2010, 22(5):395-397, 401.
15.	周国锋, 冯敢生, 梁惠明, 等. 脾动脉栓塞治疗胰源性假性脾动脉瘤[J]. 中华放射学杂志, 2005, 39(4):387-389.
16.	李惠民, 董伟华, 肖湘生, 等. 多层CT血管造影诊断脾动脉瘤的价值[J]. 第二军医大学学报, 2003, 24(5):484-487.
17.	Donckier V, Rypens F, van de Stadt J. Unusual splenic complication of acute pancreatitis[J]. J Clin Gastroenterol, 1992, 15(3):245-247.
18.	Toussi HR, Cross KS, Sheehan SJ, et al. Spontaneous splenic rupture:a rare complication of acute pancreatitis[J]. Br J Surg, 1996, 83(5):632.
19.	李贺, 项和平. 急性重症胰腺炎治疗进展[J]. 安徽医学, 2010, 31(11):1381-1383.
20.	张圣道, 雷若庆. 重症急性胰腺炎诊治指南[J]. 中华外科杂志, 2007, 1(10):34-36.
21.	Thompson JE, Ashley SW. Subcapsular hematoma of the spleen associated with acute pancreatitis[J]. Surgery, 1997, 121(2):231-233.
22.	Gallagher PJ, Mclauchlin G, Bornman PC, et al. Diagnostic pitfalls and therapeutic strategies in the treatment of pancreatic duct haemorrhage[J]. HPB Surg, 1997, 10(5):293-297.
23.	蔡迪明, 罗燕, 李永忠, 等. 超声造影在急性胰腺炎脾血管并发症诊断中的价值[J]. 世界华人消化杂志, 2013, 21(16):1554-1558.
24.	张生彬, 周永升, 张阳德. 重症急性胰腺炎合并上消化道出血的原因及诊治[J]. 中国现代医学杂志, 2011, 21(7):833-836, 845.
25.	Patil PV, Khalil A, Thaha MA. Splenic parenchymal complications in pancreatitis[J]. JOP, 2011, 12(3):287-291.
26.	杜金柱, 许斌. 重症急性胰腺炎诊治进展[J]. 辽宁中医药大学学报, 2011, 13(10):266-268.
27.	Balthazar EJ. Acute pancreatitis:assessment of severity with clinical and CT evaluation[J]. Radiology, 2002, 223(3):603-613.
28.	Mäkelä JT, Eila H, Kiviniemi H, et al. Computed tomography severity index and C-reactive protein values predicting mortality in emergency and intensive care units for patients with severe acute pancreatitis[J]. Am J Surg, 2007, 194(1):30-34.
29.	Lu Q, Zhong Y, Wen XR, et al. Can contrast-enhanced ultrasound evaluate the severity of acute pancreatitis?[J]. Dig Dis Sci, 2011, 56(5):1578-1584.
30.	Gandolfi L, Torresan F, Solmi L, et al. The role of ultrasound in biliary and pancreatic diseases[J]. Eur J Ultrasound, 2003, 16(3):141-159.
31.	Luo Y, Yuan CX, Peng YL, et al. Can ultrasound predict the severity of acute pancreatitis early by observing acute fluid collection?[J]. World J Gastroenterol, 2001, 7(2):293-295.
32.	Rickes S, Uhle C, Kahl S, et al. Echo enhanced ultrasound:a new valid initial imaging approach for severe acute pancreatitis[J]. Gut, 2006, 55(1):74-78.
33.	Rickes S, Mönkemüller K, Malfertheiner P. Acute severe pancreatitis:contrast-enhanced sonography[J]. Abdom Imaging, 2007, 32(3):362-364.
34.	Rickes S, Rauh P, Uhle C, et al. Contrast-enhanced sonography in pancreatic diseases[J]. Eur J Radiol, 2007, 64(2):183-188.
35.	Cai DM, Parajuly SS, Ling WW, et al. Diagnostic value of contrast enhanced ultrasound for splenic artery complications following acute pancreatitis[J]. World J Gastroenterol, 2014, 20(4):1088-1094.
36.	Albrecht T, Blomley M, Bolondi L, et al. Guidelines for the use of contrast agents in ultrasound. January 2004[J]. Ultraschall Med, 2004, 25(4):249-256.
37.	张继, 田为中, 陈锦华. 急性胰腺炎的MRI特征与评价[J]. 海南医学, 2010, 21(23):101-103.
38.	潘华山, 张小明. 急性胰腺炎的MRI评价[J]. 国际医学放射学杂志, 2010, 33(1):34-37.
39.	李晓光, 张晓波, 石海峰, 等. 胰腺炎并发假性动脉瘤大出血的影像诊断及其经导管动脉栓塞治疗[J]. 协和医学杂志, 2010, 1(1):77-81.

1. Mallory TB. Pathology[J]. N Engl J Med, 1947, 236(12):438-443.
2. Fishman EK, Soyer P, Bliss DF, et al. Splenic involvement in pancreatitis:spectrum of CT findings[J]. AJR Am J Roentgenol, 1995, 164(3):631-635.
3. 武先聪. 急性胰腺炎及其并发症超声现象探讨[J]. 检验医学与临床, 2011, 8(11):1326-1327.
4. Caslowitz PL, Labs JD, Fishman EK, et al. Nontraumatic focal lesions of the spleen:assessment of imaging and clinical evaluation[J]. Comput Med Imaging Graph, 1990, 14(2):133-141.
5. Malka D, Hammel P, Lévy P, et al. Splenic complications in chronic pancreatitis:prevalence and risk factors in a medical-surgical series of 500 patients[J]. Br J Surg, 1998, 85(12):1645-1649.
6. Mortele KJ, Mergo PJ, Taylor HM, et al. Splenic and perisplenic involvement in acute pancreatitis:determination of prevalence and morphologic helical CT features[J]. J Comput Assist Tomogr, 2001, 25(1):50-54.
7. 中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会, 中华消化杂志编辑委员会. 中国急性胰腺炎诊治指南(2013年, 上海)[J]. 中华消化杂志, 2013, 33(4):217-222.
8. Carr SC, Mahvi DM, Hoch JR, et al. Visceral artery aneurysm rupture[J]. J Vasc Surg, 2001, 33(4):806-811.
9. Rypens F, Devière J, Zalcman M, et al. Splenic parenchymal complications of pancreatitis:CT findings and natural history[J]. J Comput Assist Tomogr, 1997, 21(1):89-93.
10. 刘树伟, 王怀经, 柳澄, 等. 右肺门支气管和血管在横断面上的配布特点[J]. 中国临床解剖学杂志, 2004, 22(5):457-462.
11. Wang L, Liu GJ, Chen YX, et al. Sinistral portal hypertension:clinical features and surgical treatment of chronic splenic vein occlusion[J]. Med Princ Pract, 2011, 21(1):20-23.
12. Sawlani V, Phadke RV, Baijal SS, et al. Arterial complications of pancreatitis and their radiological management[J]. Australas Radiol, 1996, 40(4):381-386.
13. 游箭, 钟立明, 胡鸿, 等. 重症急性胰腺炎并发大出血的血管造影和栓塞治疗[J]. 当代医学, 2009, 3(5):18-20.
14. 杜章, 吴昊, 吴伟林, 等. 不同严重程度急性胰腺炎大鼠IL-17、IL-23的表达及其相关性[J]. 肝胆胰外科杂志, 2010, 22(5):395-397, 401.
15. 周国锋, 冯敢生, 梁惠明, 等. 脾动脉栓塞治疗胰源性假性脾动脉瘤[J]. 中华放射学杂志, 2005, 39(4):387-389.
16. 李惠民, 董伟华, 肖湘生, 等. 多层CT血管造影诊断脾动脉瘤的价值[J]. 第二军医大学学报, 2003, 24(5):484-487.
17. Donckier V, Rypens F, van de Stadt J. Unusual splenic complication of acute pancreatitis[J]. J Clin Gastroenterol, 1992, 15(3):245-247.
18. Toussi HR, Cross KS, Sheehan SJ, et al. Spontaneous splenic rupture:a rare complication of acute pancreatitis[J]. Br J Surg, 1996, 83(5):632.
19. 李贺, 项和平. 急性重症胰腺炎治疗进展[J]. 安徽医学, 2010, 31(11):1381-1383.
20. 张圣道, 雷若庆. 重症急性胰腺炎诊治指南[J]. 中华外科杂志, 2007, 1(10):34-36.
21. Thompson JE, Ashley SW. Subcapsular hematoma of the spleen associated with acute pancreatitis[J]. Surgery, 1997, 121(2):231-233.
22. Gallagher PJ, Mclauchlin G, Bornman PC, et al. Diagnostic pitfalls and therapeutic strategies in the treatment of pancreatic duct haemorrhage[J]. HPB Surg, 1997, 10(5):293-297.
23. 蔡迪明, 罗燕, 李永忠, 等. 超声造影在急性胰腺炎脾血管并发症诊断中的价值[J]. 世界华人消化杂志, 2013, 21(16):1554-1558.
24. 张生彬, 周永升, 张阳德. 重症急性胰腺炎合并上消化道出血的原因及诊治[J]. 中国现代医学杂志, 2011, 21(7):833-836, 845.
25. Patil PV, Khalil A, Thaha MA. Splenic parenchymal complications in pancreatitis[J]. JOP, 2011, 12(3):287-291.
26. 杜金柱, 许斌. 重症急性胰腺炎诊治进展[J]. 辽宁中医药大学学报, 2011, 13(10):266-268.
27. Balthazar EJ. Acute pancreatitis:assessment of severity with clinical and CT evaluation[J]. Radiology, 2002, 223(3):603-613.
28. Mäkelä JT, Eila H, Kiviniemi H, et al. Computed tomography severity index and C-reactive protein values predicting mortality in emergency and intensive care units for patients with severe acute pancreatitis[J]. Am J Surg, 2007, 194(1):30-34.
29. Lu Q, Zhong Y, Wen XR, et al. Can contrast-enhanced ultrasound evaluate the severity of acute pancreatitis?[J]. Dig Dis Sci, 2011, 56(5):1578-1584.
30. Gandolfi L, Torresan F, Solmi L, et al. The role of ultrasound in biliary and pancreatic diseases[J]. Eur J Ultrasound, 2003, 16(3):141-159.
31. Luo Y, Yuan CX, Peng YL, et al. Can ultrasound predict the severity of acute pancreatitis early by observing acute fluid collection?[J]. World J Gastroenterol, 2001, 7(2):293-295.
32. Rickes S, Uhle C, Kahl S, et al. Echo enhanced ultrasound:a new valid initial imaging approach for severe acute pancreatitis[J]. Gut, 2006, 55(1):74-78.
33. Rickes S, Mönkemüller K, Malfertheiner P. Acute severe pancreatitis:contrast-enhanced sonography[J]. Abdom Imaging, 2007, 32(3):362-364.
34. Rickes S, Rauh P, Uhle C, et al. Contrast-enhanced sonography in pancreatic diseases[J]. Eur J Radiol, 2007, 64(2):183-188.
35. Cai DM, Parajuly SS, Ling WW, et al. Diagnostic value of contrast enhanced ultrasound for splenic artery complications following acute pancreatitis[J]. World J Gastroenterol, 2014, 20(4):1088-1094.
36. Albrecht T, Blomley M, Bolondi L, et al. Guidelines for the use of contrast agents in ultrasound. January 2004[J]. Ultraschall Med, 2004, 25(4):249-256.
37. 张继, 田为中, 陈锦华. 急性胰腺炎的MRI特征与评价[J]. 海南医学, 2010, 21(23):101-103.
38. 潘华山, 张小明. 急性胰腺炎的MRI评价[J]. 国际医学放射学杂志, 2010, 33(1):34-37.
39. 李晓光, 张晓波, 石海峰, 等. 胰腺炎并发假性动脉瘤大出血的影像诊断及其经导管动脉栓塞治疗[J]. 协和医学杂志, 2010, 1(1):77-81.

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胰腺炎脾血管并发症的解剖与诊断进展

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