胰十二指肠手术病人腹主动脉旁淋巴结转移的CT评估

发布时间：2018-03-10 20:09

本文选题：CT　切入点：腹主动脉旁淋巴结　出处：《东南大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的研究胰十二指肠手术病人术前CT影像中腹主动脉旁淋巴结(Para-aortic lymph Node, PALN,又称第16组淋巴结)肿大特征与病理阳性间的关系,为术前判断这类病人是否存在PALN转移提供有意义的参考。方法分析2010年1月至2015年2月我们完成的54例胰十二指肠切除且术中腹主动脉旁淋巴结单独送检的病例资料,其中东南大学附属中大医院26例,连云港市第一人民医院28例。病例按照送检的第十六组淋巴结(腹主动脉旁淋巴结)病理结果阳性与否,分为PALN日性组(n=12)和PALN阴性组(n=42)。记录CT影像层面中最大淋巴结长径、最大淋巴结短径、淋巴结数量,并比较其在两组病例中的差异。对有显著差异者,用ROC曲线确定判断PALN阳性的最佳分界值,评估其判断PALN阳性与否的诊断价值。根据电话回访结果,绘制生存曲线,比较两组术后生存时间的差异。结果两组间淋巴结数量和最大淋巴结长径均无明显差异(p0.05)。PALN阳性组在CT上的最大淋巴结短径明显大于PALN阴性组(9.3±4. Omm vs 5.5±3.0mm) (p0.05)。检测最大淋巴结短径的ROC曲线的面积为0.769。区分PALN转移与否的最佳分界值为最大淋巴结短径大于或等于8mm,其判断PALN转移与否的准确性为72.3%,敏感性为72.7%,特异性为72.2%。PALN阳性患者预后明显比PALN阴性者差(p0.001)。结论手术前CT影像能提供PALN大小信息,PALN肿大可能提示该淋巴结病理阳性转移,其中最大淋巴结短径具有临床意义。
[Abstract]:Objective to study the relationship between the enlargement of para-aortic lymph Node (PALN) and pathological positive in preoperative CT images of patients undergoing pancreaticoduodenal surgery. Methods from January 2010 to February 2015, 54 patients underwent pancreaticoduodenectomy and underwent abdominal para-aortic lymph node examination. Among them, 26 cases were affiliated to the Chinese University of Southeast University and 28 cases were from Lianyungang first people's Hospital. According to the pathological results of 16th groups of lymph nodes (adjacent to abdominal aorta), It was divided into PALN diurnal group (n = 12) and PALN negative group (n = 42). The maximal long diameter, short diameter and number of lymph nodes were recorded on CT images, and the differences between the two groups were compared. ROC curve was used to determine the best threshold value of PALN positive, and to evaluate the diagnostic value of PALN positive or not. According to the result of telephone call back, the survival curve was drawn. Results there was no significant difference in the number of lymph nodes and the maximum length of lymph nodes between the two groups. The maximal short diameter of lymph nodes on CT in the positive group was significantly larger than that in the negative group of PALN (9.3 卤4. Omm vs 5.5 卤3.0 mm) (p0.05). The area of ROC curve of short diameter of large lymph node is 0.769.The best value of differentiating PALN metastasis or not is that the maximum short diameter of lymph node is greater than or equal to 8mm, the accuracy of judging the metastasis of PALN is 72.3%, the sensitivity is 72.7 and the specificity is 72.2%. The prognosis of the patients with negative PALN was significantly worse than that of the patients with negative PALN. Conclusion CT images before operation can provide the information of the size of PALN and the enlargement of PALN, which may indicate the positive metastasis of the lymph node. The short diameter of the largest lymph node is of clinical significance.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.5

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