从胰腺的受累部位探讨急性胰腺炎的发病机制

摘要

Objective To study pathogenesis of pancreatitis through manifestation of computed tomography. Methods Clinical data of computed tomography of 408 patients with acute pancreatitis was analyzed retrospectively. Results Computed tomographic examination were more indicative of injury of pancreas body and tail in most of patients while injury of pancreas head was not common. Injury of pancreas body and tail in patients with mild acute pancreatitis and hyperlipidemia-induced pancreatitis were common; whole pancreas in patients with severe acute pancreatitis was damaged.Conclusion Pancreatic microcirculation dysfunction is the important patogenesis of acute pancreatitis besides self-digestion induced by activation of pancreatic enzyme. Image change furthure shows that improving pancreatic microcirculation is a key method to treat patients with acute pancreatitis, beside restraining secretion of pancreatic juice and activity of pancreatic enzymey.%目的 分析胰腺炎时胰腺的常见累及部位及病因,初步探讨急性胰腺炎的发病机制.方法 对2000年2月~2010年10月在我院住院的408例急性胰腺炎患者的累及部位及病因作回顾分析.结果 74.0%患者为高脂血症导致的胰腺炎;100%胰腺炎患者胰腺尾部受累,83.8%患者为胰腺尾部或体尾部受累.高脂血症性胰腺炎以体尾部或头体尾部同时受累为主,胆源性胰腺炎主要以胰腺尾部或体尾部受累为主,两者比较差异显著(χ2=96.1,P＜0.01).轻症胰腺炎主要为胰腺尾部和/或体尾部受累;重症胰腺炎主要为体尾部或整个胰腺受累.两者在受累部位方面比较具有显著差异(χ2=187.5,P＜0.01).胆源性胰腺炎主要是轻症胰腺炎,高脂血症性胰腺炎中重症胰腺炎的发生率明显高于胆源性胰腺炎.两者相比差异显著(χ2=10.9,P＜0.05).结论 胰腺炎的受累部位提示胰腺炎的发生除胰酶激活引起自身消化之外,胰腺微循环障碍造成胰腺实质缺血缺氧亦是重要的发病机制.对于胰腺炎的治疗除了抑制胰液分泌,抑制胰酶活性之外,改善胰腺微循环亦是非常重要的措施.