腹腔神经节的MSCT表现及胰腺癌胰外神经侵犯MSCT诊断的初步探讨

发布时间：2018-01-08 17:10

  本文关键词：腹腔神经节的MSCT表现及胰腺癌胰外神经侵犯MSCT诊断的初步探讨　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

  更多相关文章： 腹腔神经节 MSCT 胰腺癌 胰外神经侵犯

【摘要】：目的：(1)分析腹腔神经节的MSCT表现,以期为临床更准确有效的进行CT引导下腹腔神经丛阻滞术及胰周神经结构影像解剖提供必要参考信息。(2)初步探讨MSCT对胰腺癌胰外神经侵犯的诊断价值。方法：(1)观察150例正常成人的腹部MSCT图像,记录和测量双侧腹腔神经节的显示率、位置、形态、大小及各期CT值,并进行相关统计学分析。(2)回顾性分析16例行手术切除和病理证实的胰腺癌患者的MSCT资料,将胰外神经走行区即病灶与腹腔神经节和(或)周围血管之间脂肪间隙内出现粗网线影或软组织密度影确定为胰外神经侵犯的MSCT征象,以病理结果为金标准,对照分析MSCT对胰腺癌胰外神经侵犯诊断的敏感性、特异性和准确性。结果：(1)、150例正常成人中左侧腹腔神经节141例显示(94%),9例不显示,右侧腹腔神经节中124例显示(82.7%),26例不显示,左侧显示率高于右侧(P=0.0040.05)。双侧腹腔神经节均位于腹腔干至肠系膜上动脉层面,平T12-L1水平；右侧腹腔神经节位于下腔静脉后内侧与右侧膈肌脚之间,左侧腹腔神经节位于左侧肾上腺前内侧与左侧膈肌脚之间。MSCT轴位图像中腹腔神经节形态分为长条形和多结节形两种,左侧长条形92例(65.2%),多结节形49例(34.8%),右侧长条形102例(82.3%),多结节形22例(17.7%),左侧多结节形多于右侧(P0.05)。左、右侧腹腔神经节长径分别为(22.8±4.1)mm、 (27.6±4.2)mm,右侧长径长于左侧长径(P0.001),左、右侧短径分别为(3.5±0.8)mm,(2.4±0.6)mm,左侧短径长于右侧短径(P0.001)。左侧腹腔神经节平扫期、动脉期、静脉期CT值为(24.8±4)HU.(53.9±7)HU.(72.4 ±10.1)HU。按性别分组：男性左、右侧腹腔神经节显示率高于女性(P0.05)。按年龄分组：(20-40岁,32人)组、(40-60岁,79人)组及(60-80岁,39人)组之间左、右两侧腹腔神经节显示率存在差异性(P0.05)；各组间对比：(20-40岁)组左、右侧腹腔神经节显示率低于(40-60岁)组(P0.0125)；(20-40岁)组与(60-80岁)组间左侧腹腔神经节显示率差异无统计学意义(P0.0125),右侧腹腔神经节显示率显示率略低于(60-80岁)组(P=0.0100.0125)；(40-60岁)组与(60-80岁)组间左、右侧腹腔神经节显示率差异均无统计学意义(P0.0125)。(2)、本研究中MSCT对胰腺癌胰外神经侵犯诊断的敏感性、特异性和准确性分别为85.7%(6/7)、55.6%(5/9)、68.8%(11/16),经病理证实有胰外神经侵犯6例中有2例病灶与腹腔神经节间隙内出现粗网线影,并与腹腔神经节边界不清,3例病灶与周围血管间隙内出现软组织密度影,1例病灶与周围血管间隙内出现粗网线影。结论：(1)MSCT多数情况下能够显示双侧腹腔神经节的位置、形态、大小等特征,左侧腹腔神经节显示率高于右侧,主要是因为右侧腹腔神经节周围结构间隙较窄,部分体型较瘦者显示不清。双侧腹腔神经节的显示率受性别和年龄因素的影响,我们认为造成这种差异的主要原因是不同性别、年龄段的体型及内脏器官饱满度不同所导致。(2)胰腺癌患者MSCT图像中癌灶与腹腔神经节和(或)周围血管之间脂肪间隙出现粗网线影或软组织密度影,高度提示胰腺癌发生胰外神经侵犯。
[Abstract]:Objective: (1) to analyze the MSCT features of abdominal ganglion, in order to provide more accurate clinical effective CT guided neurolytic celiac plexus block and peripancreatic nerve anatomy structure to provide the necessary reference information. (2) to investigate the value of MSCT diagnosis of pancreatic cancer pancreatic neural invasion. Methods: (1) the abdomen MSCT images were observed in 150 cases of normal adults, record and measure the bilateral abdominal ganglion display rate, location, shape, size and the CT value, and the related statistical analysis. (2) a retrospective analysis of MSCT data of patients with pancreatic cancer 16 cases of surgical resection and confirmed by pathology, the extrapancreatic nerve area the lesion and the celiac ganglia and (or) peripheral blood vessels appeared in the gap between fat coarse wire shadow or soft tissue density to determine the MSCT signs of extrapancreatic nerve invasion, with pathological results as the gold standard, a comparative analysis of MSCT for pancreatic cancer diagnosis of pancreatic nerve invasion The sensitivity, specificity and accuracy. Results: (1), 150 cases showed 141 cases of left normal adult celiac ganglion (94%), 9 cases showed that 124 cases showed right celiac ganglion (82.7%), 26 cases showed that the left display rate is higher than the right side (P=0.0040.05). The bilateral abdominal ganglion were located in the celiac superior mesenteric artery to the level, the level of T12-L1; the right celiac ganglion is located between the inferior vena cava and right posterior medial crura of diaphragm, left celiac ganglion is located between the left adrenal gland and left anterior medial crura of diaphragm ganglion form abdominal axial.MSCT image is divided into rectangular shape and multiple nodules in two, left the strip 92 cases (65.2%), 49 cases of multiple nodules (34.8%), 102 cases on the right side of the strip (82.3%), 22 cases of multiple nodules (17.7%), left more nodules than in the right (P0.05). The left and right abdominal ganglion size respectively (22.8 + 4.1) mm, (27.6 + 4.2) mm ,鍙充晶闀垮緞闀夸簬宸︿晶闀垮緞(P0.001),宸，

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