EUS与B超、CT、MRI对胰腺癌可切除性的比较研究

发布时间：2018-12-15 16:05

【摘要】：研究目的：随着医学技术的发展,医疗检查设备的更新,胰腺癌的检出率不断提高,但这种疾病在得到诊断时往往处于晚期,病程进展快,预后差,而根治性胰腺癌切除术是目前最有效的方法,但这种手术创伤大,术后患者恢复慢,术前如果没有准确充分的可切除性评估,对于不可切除的患者来说既增加了创伤又没有很好的治疗效果,故而术前有效的影像学评估非常重要。近年来,随着内镜技术的发展,超声内镜逐渐运用于胰腺癌的诊疗过程中,本研究将超声内镜检查与目前常用的B超、CT、MRI三种检查方式对比,判断其各自在胰腺癌可切除性方面的价值所在,寻求术前判断其可切除性的最佳方法。研究方法：本研究搜集整理了兰州大学第一医院普外二科2013年4月-2014年12月间,经B超、腹部增强CT及MRI检查,拟诊断为胰腺癌的41例患者,准备行胰腺癌根治性切除术,术前进一步行超声内镜检查判断其可切除性的患者病例资料,分析各项辅助检查中病灶的大小及部位、血管侵犯情况、淋巴结转移情况、有无远处转移等方面,进一步评判其可切除性,并以此来比较EUS相对于B超、腹部增强CT、MRI检查在胰腺癌可切除性方面的评估价值。研究结果：41例入组的患者均开腹手术治疗,成功根治性切除26例,未切除15例,病理证实入组患者均确诊为胰腺癌。EUS检查与增强CT、MRI在胰腺癌可切除性判断结果比较,差异有统计学意义(P0.05),腹部增强CT、MRI、EUS、CT结合EUS、MRI结合EUS等判定方法与术中实际情况检验κ值分别为0.89、0.79、0.84、0.95、0.89,腹部增强CT结合EUS在胰腺癌术前可切除性评判与术中实际情况一致性最高。结论：经腹部B超因其诊断价值较低,故而不适用于胰腺癌可切除性判断。腹部增强CT、MRI、EUS检查对于胰腺癌的可切除性均有着较为重要的临床价值,EUS是内镜与超声的结合体,其可直接观察消化道黏膜,亦可灵活进行实时超声扫查,获取消化道管壁层次及胰周重要血管、淋巴结等部位是否受侵犯的准确图像。增强CT结合EUS是术前判断胰腺癌是否可切除的最佳选择。
[Abstract]:Objective: with the development of medical technology and the renewal of medical examination equipment, the detection rate of pancreatic cancer is increasing. However, the diagnosis of this disease is often in the late stage, the course of disease progress quickly, and the prognosis is poor. Radical resection of pancreatic cancer is the most effective method at present, but the surgical trauma is great and the patient recovers slowly. If there is no accurate and sufficient resectability assessment before operation, For unresectable patients, the trauma is increased and the therapeutic effect is not good, so effective imaging evaluation before operation is very important. In recent years, with the development of endoscopic technology, ultrasound endoscopy is gradually used in the diagnosis and treatment of pancreatic cancer. To determine their respective value in resectability of pancreatic cancer and to find the best method to determine the resectability of pancreatic cancer before operation. Methods: from April 2013 to December 2014, 41 patients with pancreatic cancer were examined by B-ultrasound, abdominal enhanced CT and MRI, and were prepared to undergo radical resection of pancreatic cancer. Further endoscopic ultrasonography was performed before operation to determine the resectability of the patients. The size and location of the lesions, vascular invasion, lymph node metastasis, and whether there were distant metastasis were analyzed. To evaluate the resectability of pancreatic cancer and compare the value of EUS with B-ultrasound, abdominal enhanced CT,MRI in evaluating the resectability of pancreatic cancer. Results: all 41 patients were treated by open surgery, 26 cases were resected successfully, 15 cases were not resected. All the patients were confirmed to be pancreatic cancer by pathology. The results of EUS and enhanced CT,MRI were compared with those of enhanced CT,MRI in judging the resectability of pancreatic cancer. The difference was statistically significant (P0.05). The 魏 values of abdominal enhanced CT,MRI,EUS,CT combined with EUS,MRI combined with EUS were 0.89 and 0.89, respectively. Abdominal contrast enhanced CT combined with EUS was the most consistent between preoperative resectability and intraoperative practice of pancreatic cancer. Conclusion: because of its low diagnostic value, transabdominal B-mode ultrasound is not suitable for judging the resectability of pancreatic cancer. Abdominal enhanced CT,MRI,EUS has important clinical value for the resectability of pancreatic cancer. EUS is a combination of endoscopy and ultrasound. It can directly observe the mucosa of digestive tract, and it can also perform real-time ultrasound scan. Obtain accurate images of the digestive tract wall, peripancreatic important vessels, lymph nodes and other parts of the invasion. Contrast-enhanced CT combined with EUS is the best choice to evaluate the resectability of pancreatic cancer before operation.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.9

【相似文献】