受胰腺癌侵犯的胰周血管可切除性的影像学界点选择

发布时间：2018-10-19 17:30

【摘要】：目的:探讨胰周血管受侵的影像学表现中的手术可切除性的临界点。方法:收集经手术病理证实或临床治疗证实的胰腺癌无远处转移患者76例,均行术前螺旋CT增强扫描,其中66例行MRI增强扫描并行三维血管重建,显示胰腺癌对周围血管的侵犯情况,根据肿瘤对血管的侵犯程度分为0级、1级、2级、3级、4级。统计各级血管的条数,并与手术结果对照。结果:39例中的138支血管受肿瘤侵犯达2级或以上,放弃手术,另37例术前评估有手术切除可能性,术中25例做了胰腺根治性切除,12例由于术前低估了一支或多支血管的受侵程度,仅做了肿块切除或姑息性治疗。术中综合评估3级、4级的血管手术均无法切除,术中综合评估0级、1级的血管手术均顺利切除,术中综合评估2级的血管受术者水平的影响而有部分切除。以2级受侵为不可切除标准,肿瘤侵犯血管的敏感性为85.5%,特异性为97.1%,阳性预测值105/105=100%,阴性预测值148/191=77.5%。结论:术前用多层螺旋CT及MRI多期增强扫描并进行三维血管重建,可提供可靠的周围血管侵犯情况,对胰腺癌术前可切除性评估有重要的临床意义,动脉2级受侵、静脉1级受侵可作为手术不可切除的最佳界点。
[Abstract]:Objective: to investigate the critical point of operative resectability in imaging manifestations of peripancreatic vascular invasion. Methods: 76 cases of pancreatic cancer without distant metastasis confirmed by operation and pathology or clinical treatment were collected. All of them underwent spiral CT enhanced scanning before operation. 66 cases underwent MRI enhanced scanning and 3D vascular reconstruction. According to the degree of invasion of pancreatic cancer to peripheral blood vessels, there were grade 0, grade 1, grade 2, grade 3 and grade 4. The number of blood vessels was counted and compared with the results of operation. Results: 138 vessels of 39 cases were involved in grade 2 or more of tumor, so they abandoned the operation, and 37 cases had the possibility of surgical resection before operation. 25 cases underwent radical pancreatectomy and 12 cases underwent mass resection or palliative treatment because of preoperative underestimation of the degree of invasion of one or more vessels. Grade 3, grade 4, grade 0, grade 1 were all successfully resected, and the influence of the level of blood vessel in grade 2 was evaluated partly. The sensitivity, specificity, positive predictive value and negative predictive value of tumor were 85.5, 97.1, 105 / 100 and 148 / 191 / 77.5, respectively. Conclusion: multislice spiral CT and MRI can provide reliable peripheral vascular invasion and evaluate the resectability of pancreatic cancer before operation. Venous grade 1 invasion can be regarded as the best point of unresectable operation.
【作者单位】：北京市第一中西医结合医院放射科;清华大学第一附属医院病理科;
【分类号】：R735.9;R730.44

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