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中华消化病与影像杂志(电子版) ›› 2022, Vol. 12 ›› Issue (02) : 123 -126. doi: 10.3877/cma.j.issn.2095-2015.2022.02.013

病例报告

超声内镜引导穿刺引流术治疗急性胰腺炎并胰腺周围脓肿一例
吴立桦1, 李晨帆2, 郑泽宇2, 郑月萍1, 刘婕1, 苏瑞章1, 谢韵2, 吴碧芳1, 万曼3, 田钊旭4, 胡益群1,()   
  1. 1. 350004 福州,福建医科大学第三临床医学院;361004 福建厦门,厦门大学附属中山医院消化内科
    2. 361004 福建厦门,厦门大学附属中山医院消化内科
    3. 434000 湖北荆州,荆州市第一人民医院消化内科
    4. 518172 广东深圳,深圳市龙岗区人民医院消化内科
  • 收稿日期:2021-08-15 出版日期:2022-04-01
  • 通信作者: 胡益群
  • 基金资助:
    福建省2019年医学创新项目(2019-CXB-31)
  • Received:2021-08-15 Published:2022-04-01
引用本文:

吴立桦, 李晨帆, 郑泽宇, 郑月萍, 刘婕, 苏瑞章, 谢韵, 吴碧芳, 万曼, 田钊旭, 胡益群. 超声内镜引导穿刺引流术治疗急性胰腺炎并胰腺周围脓肿一例[J]. 中华消化病与影像杂志(电子版), 2022, 12(02): 123-126.

图1 该患者入院时胰腺CT表现。显示胰腺明显肿大,实质正常羽毛结构消失;胰腺边缘模糊,周围渗出液明显
图2 该患者入院第11日胰腺CT表现。显示胰腺弥漫性增大,可见一巨大包裹性积液积气影,有薄壁
图3 超声引导下经胃胰腺周围脓肿穿刺引流。图A、B显示10F热切开环切入脓腔,经导丝放置支架;图C、D为X线检查显示导丝囊肿内盘绕数圈,可见10F塑料支架;图E为超声内镜检查显示胰腺周围可见巨大低回声团块,内部多发高回声絮状影,可见飘动(箭头所示);图F为超声引导下穿刺引流,穿刺针自右上方穿入脓腔
图4 该患者超声内镜引导下穿刺引流术后CT表现。图A显示胰腺周围仍可见一巨大包裹性积液积气影,较前缩小,内见气体影;图B显示原胰腺内混杂低密度影/气体影较前明显减少,胰腺周围脂肪减间隙仍模糊不清,胃左下方可见囊状影,内可见气液平面,胆总管内可见管状影留置
图5 超声内镜穿刺引流瘘口球囊扩张,胃镜进入胰腺脓肿行坏死物经胃清理。图A显示塑料支架和鼻胆管引流在位,旁可见乳糜样脓液流出;图B显示十二指肠球部后壁可见一窦道(箭头所示);图C、D显示行超声内镜穿刺引流瘘口扩张术,胃体窦道以三级球囊扩张至1.5 cm;图E、F显示窦道内可见大量坏死组织,予以圈套器、异物钳、网篮抓取坏死组织
图6 该患者超声内镜穿刺引流瘘口扩张术后CT表现。显示胰管较扩张,实质密度仍欠均匀;胰腺周围脂肪间隙稍模糊,胰周渗出液较前减少;胆总管-十二指肠内可见管状影留置
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