胰腺炎的超声表现--中日两组病例的比较
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| 时间：2008-12-24 17:27:52 来源： 作者： |
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Objective: To compare the sonographic characteristics of pancreatitis between two groups of Chinese and Japanese. Methods: Sonographic examination was performed in 59 cases of chronic pancreatitis and 84 cases of acute pancreatitis in Sun Yat-sen university (group A) and 128 cases of chronic pancreatitis and 95 cases of acute pancreatitis in Japanese Kyorin University (group B). The sonographic features of the two groups were analyzed. Results: For chronic pancreatitis, the detection rates of pancreatic duct dilation and pancreatic calcification in group A were significantly lower than those in group B, being 23.7% vs 53.0%,13.6% vs 27.3%, respectively (both p<0.01). The concurrent rates of pancreatic stone and gallstone were significantly different between group A and group B, being 18.6% vs 54.7%, 52.5% vs 7.0%, respectively (both p<0.01). For acute pancreatitis, there was no significant difference with regard to the sonographic features between two groups (p>0.05), whereas the concurrent rates of pancreatic stone and gallstone were significantly different between group A and group B, being 0.0% vs 8.4%, 42.9% vs 7.4%, respectively (both p<0.01). Conclusion: The major sonographic features of chronic pancreatitis from Japanese group were pancreatic duct dilation and pancreatic calcification. The cases of pancreatitis from China and Japan were characterized as high concurrent rate of gallstone and pancreatic stone, respectively.
Key word: Sonography, Chronic pancreatitis, Acute pancreatitis
胰腺炎为常见疾病,一般认为日本胰腺炎以酒精性多见[1，3，4]， 而胆源性胰腺炎在中国更常见。这两种不同病因导致的胰腺炎在超声图像上可能有不同的特点，本研究旨在通过分析中日两组胰腺炎病例的超声表现，发现其不同之处。
资料和方法
研究对象包括中山大学附属第一医院（简称A组）1995-1999年慢性胰腺炎59例、急性胰腺炎84例，日本杏林大学（简称B组）1994-1998年慢性胰腺炎128例，急性胰腺炎95例。两组慢性胰腺炎的平均年龄分别为55.4±17.3岁、56.2±18.9岁，两组急性胰腺炎的平均年龄分别为50.7±19.4 岁、52.9±20.1岁。
42例急性胰腺炎（A组23 例、B组19例）、23例慢性胰腺炎（A组8例、B组15例）经手术证实，11例慢性胰腺炎经皮超声引导下穿刺病理活检证实（A组7例、B组5例），其他虽无病理诊断但符合下列临床诊断标准：慢性胰腺炎①反复上腹疼痛不适、厌食、消化不良，或内外分泌功能不足的表现，排除因其他疾病引起的症状。②实验室检查有不同程度的胰酶反复升高。③超声、CT、ERCP、EUS中任何一项检查发现胰腺钙化、结石、胰管不规则扩张等形态学改变。急性胰腺炎①急性上腹痛、压痛、反跳痛，可排除胃、十二指肠、肝胆疾病引起的症状。②血尿淀粉酶升高。③一种以上的影像学检查有胰腺肿大、胰周积液等形态学改变[1]。
使用仪器： ALOKA SSD-2000及东芝270超声显像仪。探头均为3.5MHz凸阵探头。
除急诊病例外，所有病例检查前均禁食８小时以上。超声观察的项目包括：胰腺的头体尾部厚度、形态、胰管内径、内部回声、结石、钙化、囊肿、胰周积液和邻近脏器情况。胰头前后径大于2.1 cm、胰体前后径大于1.6cm为胰腺肿大，胰管内径达到0.3cm则诊断为胰管扩张。点状强回声后方伴声影者诊断为结石，后方无声影者为钙化。
结果
1． 两组慢性胰腺炎的超声表现
A组中胰管扩张、胰腺钙化的检出率明显低于B组 (均P<0.01)（图1、2）。其余超声表现如假性囊肿、回声不均、肿块形成、萎缩、增大等在两组间无明显差异(P>0.05)（表1）。此外，在A组及B组中分别有20.3%及14.6%的病例超声检查未见任何异常（表1）。
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