胰头癌的MRCP临床应用研究

本文研究探讨胰胆管磁共振水成像(MRCP)对胰头癌的临床诊断意义。通过经手术和病理证实的21例胰头癌病例的术前胰胆管磁共振水成像表现,应用MRCP扫描,扫描序列包括SE序列T1WI、FSE序列T2WI、T1WIFS、T2WIFS、MRCP冠状位扫描成像。21例胰头癌胰胆管磁共振水成像上,均有胆总管胰头段及主胰管胰头段因癌瘤侵袭而破坏截断和其残留段扩张的征象。20例胰头癌通过胰胆管磁共振水成像扫描确诊,1例胰头癌误诊为慢性胰头炎。     

MRCP对胰头癌与胰头部肿块型慢性胰腺炎的鉴别诊断价值

目的探讨磁共振胰胆管成像（MRCP）对胰头癌与胰头部肿块型慢性胰腺炎的诊断与鉴别诊断价值。方法分析30例胰头癌与30例胰头部肿块型慢性胰腺炎患者的MRCP表现。结果胰头癌组的MRCP征象包括不相交征（83.3%）、双管征（46.7%）、四管征（36.7%）、软藤征（36.7%）、胰管贯通征（13.3%）。胰头部肿块型慢性胰腺炎的MRCP特征包括双管征（20%）、枯树枝征（36.7%）、胰管贯通征（86.7%）。结论双管征和软藤征是胰头癌的重要征象,四管征与不相交征是胰头癌的特异性征象;枯树枝征是胰头部肿块型慢性胰腺炎的重要征象,胰管穿通征是肿块型胰腺炎的特异性征象。     

早期胰头癌的CT诊断

胰腺癌是胰腺常见的恶性肿瘤，胰头则是胰腺癌的好发部位。既往由于认识不足及受影像设备的限制。加之胰腺本身位置深，发生病变时症状出现较晚等因素，使胰腺癌的早期诊断甚为困难。待患者出现明显症状，临床上发现胰头发生癌肿，大多已为中晚期，难以手术切除。近年来，随着对早期胰腺癌研究的深入及影像技术的发展，尤其是螺旋CT的应     

恶性梗阻性黄疸的MRCP征象探讨

磁共振胰胆管造影(MRCP)是一种胰胆管成像新技术,近年来已被广泛应用于胰胆管系统疾病的诊断.其可高达100%的准确定位诊断能力已经得到国内外学者的认可[1].     

胰头增大的诊断及鉴别

分析我院临床难以确诊的64例胰头增大病员,经病理、手术证实其中胰头癌40例,慢性胰腺炎24例。结果提示术前胰头癌与慢性胰腺炎的鉴别应从临床表现、影象学所见特别是胰胆管的改变等进行综合分析。     

胰头癌的外科治疗

胰腺癌有“围管浸润”的特点 ,其临床症状早期不典型 ,易早期发生血行和淋巴转移 ,又缺乏应有的警惕及重视 ,使胰腺癌的治疗非常困难。早期胰腺癌仍以外科手术治疗为首选。有人报告 , 、 期胰腺癌的手术切除率为 10 0 % ,5年生存率为2 0 %～ 40 %。1　胰十二指肠切除术胰十二指肠切除术仍是胰头癌的规范化术式。近几十年来经许多外科学家的努力和改进 ,其手术切除率和术后生存率不断提高 ,但胰十二指肠切除术仍为风险大、手术并发症多的高难度手术。所以 ,应用此术式时应慎重。1.1　手术指征　 1胰头癌早期 ,即 、 期及部分 期患者 ;2年龄…     

老年人胰头癌手术疗效分析

目的：探讨老年胰头癌Wipple手术的疗效特殊性及规律。方法：以临床表现，诊断方法，辅助检查，围手术期并发症，术式选择，术后随访结果等与中青年组作对比分析。结果：术后生存期老年人低于中青年患者。手术可切除率，两组无显著性差异，不能手术者自然生存期最差。结果：对老年胰头癌者，手术仍为首选，且以一期尽早为宜，但手术远期疗效及术后并发症等负面效应较中青年者要大。扩大术式，术前减黄均无必要，关键在早诊断，早手术。     

CT与B超对胰头癌诊断的对比分析

目的 探讨胰头癌的超声学特点和B超在胰头癌诊断中的价值.方法 对38例疑为胰腺癌患者进行胰腺B超检查及CT检查,并与病理结果对照.同时对比观察B超和CT在胰头癌诊断中的异同.结果 38例疑为胰腺癌的患病者最终有28例证实为胰头癌患者,B超检查检出21例,诊断符合率为75.0%,CT检出24例,诊断符合率为85.7%.B超与CT比较,各项观察指标均无统计学差异(P均>0.05).结论 B超和CT对胰头癌检查诊断符合率基本一致.     

胰头十二指肠切除术

胰头十二指肠切除术是普通外科最复杂的手术之一.近年来,采用胰头十二指肠切除治疗良恶性病变增加.一方面,放射学水平的进展利于病变的精确诊断和治疗;另一方面,也归功于围术期处理水平的提高和外科手术技术的进步.湖南省人民医院肝胆医院1990-01/2007-12施行胰头十二指肠切除术604例,手术死亡率仅0.3%,手术效果优良.本文以胰头癌手术为例,介绍我们关于胰头十二指肠切除术的一些经验.     

重视中晚期胰头癌的综合治疗

尽管针对胰腺癌的影像学诊断和分子生物学诊断取得了相当的进展,但其早期诊断问题远未解决,85％的患者就诊时已属晚期。美国的资料显示胰腺癌的手术切除率和5年生存率在过去20年中并无明显变化。因此中晚期胰腺癌问题是临床胰腺癌诊治的重点,应高度重视。     

Utility of pancreatic duct brushing for diagnosis of pancreatic carcinoma

Background The aim of this study was to evaluate the usefulness of pancreatic duct brushing for diagnosis of pancreatic carcinoma. Methods Brush cytology was attempted in 58 patients suspected of having pancreatic malignancy because of stricture of the main pancreatic duct, confirmed by endoscopic retrograde cholangiopancreatography. Thirty-eight patients were finally diagnosed by an operation or the clinical course as having pancreatic carcinoma, and the remaining 20 patients as having chronic pancreatitis. The usefulness of brush cytology for diagnosis of pancreatic carcinoma was estimated. We interpreted failures of pancreatic duct brushing to be false negatives when the lesion was malignant. Results In 48 of 58 patients (82.8%), brushing was successfully performed and satisfactory specimens were obtained. Brush cytology was positive in 25 of 38 patients with pancreatic carcinoma (sensitivity 65.8%) and negative in all patients without malignancy (specificity 100%). Overall accuracy was 76.4%. During 2001–2005, the number of back-and-forth motions of the brush was increased to more than 30 times. The sensitivity significantly improved from 43.8% in 1997–2000 to 81.8% in 2001–2005 (P < 0.05). The increased success rate of brushing by improvement of skill in manipulating the guidewire and increased number of cells smeared on glass slides by increased back-and-forth motion of the brush may account for this improvement over time. Moreover, the sensitivity in 2001–2005 was 85.7% if failures of brushing with pancreatic carcinoma are excluded. No major complications occurred, except for two patients with a moderate grade of acute pancreatitis. Conclusions Although further studies with a large number of patients are needed, our results suggest that with recent improvements of the brushing technique, pancreatic duct brushing is a useful and safe method for the differential diagnosis of malignancy from benign diseases of the pancreas.     

Magnetic resonance imaging in the detection of pancreatic neoplasms

Recently, with the rapid scanning time and improved image quality, outstanding advances in magnetic resonance (MR) methods have resulted in an increase in the use of MRI for patients with a variety of pancreatic neoplasms. MR multi-imaging protocol, which includes MR cross-sectional imaging, MR cholangiopancreatography and dynamic contrast-enhanced MR angiography, integrates the advantages of various special imaging techniques. The non-invasive all-in-one MR multi-imaging techniques may provide the comprehensive information needed for the preoperative diagnosis and evaluation of pancreatic neoplasms. Pancreatic neoplasms include primary tumors and pancreatic metastases. Primary tumors of the pancreas may be mainly classified as ductal adenocarcinomas, cystic tumors and islet cell tumors (ICT). Pancreatic adenocarcinomas can be diagnosed in a MRI study depending on direct evidence or both direct and indirect evidence. The combined MRI features of a focal pancreatic mass, pancreatic duct dilatation and parenchymal atrophy are highly suggestive of a ductal adenocarcinoma. Most cystic neoplasms of the pancreas are either microcystic adenomas or mucinous cystic neoplasms. Intraductal papillary mucinous tumors are the uncommon low-grade malignancy of the pancreatic duct. ICT are rare neoplasms arising from neuroendocrine cells in the pancreas or the periampullary region. ICT are classified as functioning and non-functioning. The most frequent tumors to metastasize to the pancreas are cancers of the breast, lung, kidney and melanoma. The majority of metastases present as large solitary masses with well-defined margins.     

Differentiation between pancreatic carcinoma and mass-forming chronic pancreatitis: usefulness of high b value diffusion-weighted imaging

OBJECTIVE: To investigate the value of high b value diffusion‐weighted (DW) imaging in differentiating between pancreatic carcinoma and mass‐forming chronic pancreatitis (MFCP). METHODS: Fifty‐one consecutive patients with pathology‐proven pancreatic carcinoma (n = 37) or MFCP (n = 14) were evaluated with DW imaging (b value, 0 and 1000 s/mm²) at a 3‐T MR system. Overall 20 healthy volunteers were evaluated as the control group. The apparent diffusion coefficient (ADC) values of normal pancreas, pancreatic carcinoma, MFCP, and mass‐associated obstructive pancreatitis were measured. RESULTS: On high b value (1000 s/mm²) DW images, both pancreatic carcinoma and MFCP were hyperintense focal lesions; mass‐associated obstructive pancreatitis occurred in 17 of 37 (45.9%) pancreatic carcinoma and 8 of 14 (57.1%) MFCP. The ADC (×10^?3 mm²/s) of the pancreatic carcinomas (1.06 ± 0.15) was significantly lower than that of normal pancreas (1.47 ± 0.18; P < 0.01), MFCP (1.35 ± 0.14; P < 0.01) and mass‐associated chronic pancreatitis (1.44 ± 0.17; P < 0.01). The ADC of MFCP was also lower than that in the normal pancreas (P = 0.025), whereas the ADC of mass‐associated obstructive pancreatitis was not different from those of the MFCP (P = 0.113) and normal pancreas (P = 0.544). When 1.195 was used as the optimal cut‐off value, ADC quantification obtained a sensitivity of 85.7% and a specificity of 86.5% for differentiating pancreatic carcinomas from MFCP. CONCLUSION: High b value DW imaging in combination with ADC quantification at a 3‐T MR system is useful in differentiating between pancreatic carcinoma and MFCP.     

Pancreatic head carcinoma:clinical analysis of 189 cases

BACKGROUND:Pancreatic cancer is a lethal disease with an increasing incidence.We retrospectively reviewed the clinical data on diagnosis and treatment of pancreatic head carcinoma,and analyzed the factors affecting prognosis of the disease. METHODS:The data of 189 patients with pancreatic head carcinoma treated from September 1,1995 to August 31,2005 were reviewed retrospectively.Ninety-four patients treated from September 1,2000 to August 31,2005 were followed up in April 2008.The median survival time(MST)...     

Pancreatic head excavation for tissue diagnosis may reduce unnecessary pancreaticoduode-nectomies in the setting of chronic pancreatitis

BACKGROUND: The necessity to obtain a tissue diagnosis of cancer prior to pancreatic surgery still remains an open debate. In fact, a non-negligible percentage of patients under-going pancreaticoduodenectomy (PD) for suspected cancer has a benign lesion at final histology. We describe an approach for patients with diagnostic uncertainty between cancer and chronic pancreatitis, with the aim of minimizing the incidence of PD for suspicious malignancy finally diagnosed as benign disease.METHODS: Eighty-eight patients (85.4%) with a clinicoradio-logical picture highly suggestive for malignancy received for-mal PD (group 1). Fifteen patients (14.6%) in whom preopera-tive diagnosis was uncertain between pancreatic cancer and chronic pancreatitis underwent pancreatic head excavation (PHEX) for intraoperative tissue diagnosis (group 2): those diagnosed as having cancer received PD, whereas those with chronic pancreatitis received pancreaticojejunostomy (PJ).RESULTS: No patient received PD for benign disease. All pa-tients in group 1 had adenocarcinoma on final histology. Eight patients of group 2 (53.3%) received PD after intraoperative diagnosis of cancer, whereas 7 (46.7%) received PJ because no malignancy was found at introperative frozen sections. No signs of cancer were encountered in patients receiving PHEX and PJ after a median follow-up of 42 months. Overall sur-vival did not differ between patients receiving PD for cancer in the group 1 and those receiving PD for cancer after PHEX in the group 2 (P=0.509).CONCLUSION: Although the described technique has been used in a very selected group of patients, our results suggest that PHEX for tissue diagnosis may reduce rates of unneces-sary PD, when the preoperative diagnosis is uncertain between cancer and chronic pancreatitis.     

Minute pancreatic carcinoma with initial symptom of acute pancreatitis

We experienced a case of minute pancreatic carcinoma in a 59‐year‐old man who complained of upper abdominal pain after drinking alcohol. Abdominal ultrasonography (US) revealed dilatation of the main pancreatic duct (MPD). Abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed slight dilatation of the MPD and its obstruction near the portal vein. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated occlusion of the MPD, and cytology of aspirated pancreatic juice was negative for malignancy. With the diagnosis of benign localized obstruction of the MPD, the patient underwent surgery. There was a clear demarcation of hardness and color of the pancreas on the left margin of the superior mesenteric vein, and the caudal pancreas was hard and fibrotic. Intraoperative US revealed slight dilatation of the MPD, and the aspiration cytology result was class IV. First, segmental resection of the pancreas was performed, but pathological examination of frozen section showed neither malignancy nor stenotic lesion. An additional small portion of the proximal pancreas was resected. The specimen included a ductal carcinoma, 5mm in diameter. Accordingly, a pylorus‐preserving pancreatoduodenectomy was performed. Microscopically, the minute carcinoma had already penetrated the duct wall and infiltrated lymph vessels and veins. The patient has been under close observation at our outpatient clinic, and so far there have been no signs of recurrence. To improve the poor prognosis of pancreatic cancer, we should be alert to the occurrence of acute pancreatitis as an initial symptom.     

自身免疫性胰腺炎与小胰腺癌的CT、MRCP征象分析

目的 分析自身免疫性胰腺炎(AIP)与小胰腺癌的CT、MRCP影像学征象的差异,提高对AIP的认识及诊断的准确率.方法 回顾性分析符合2008年AIP亚洲诊断标准的24例AIP及病理证实的25例小胰腺癌(≤2 cm)的影像学资料,从胰腺的形态改变、密度及强化方式、胰管及胰周、胰外表现等方面进行比较,采用×2检验或确切概率法行统计学处理.结果 在AIP和小胰腺癌组间,肿块部位、远端胰腺萎缩、肿块持续强化、胰管“截断征”、“鞘膜征”及肾脏受累征象差异具有统计学意义(x2 =9.010、10.506、15.288、8.688、6.292和4.966,P＜0.05),但是只有远端胰腺萎缩和肿块持续强化征象在局限性AIP与小胰腺癌组间差异具有统计学意义(P＜0.05).结论 弥漫性AIP的影像学改变具有特异性,与小胰腺癌容易鉴别诊断,但局灶性AIP与小胰腺癌鉴别诊断价值有限.     

Resectable carcinoma of the pancreatic head developing 7 years and 4 months after distal pancreatectomy for carcinoma of the pancreatic tail

A 67‐year‐old woman was referred with an abnormal finding on an abdominal echogram but presented with no symptoms; a pancreatic tail tumor was detected by ultrasonography. Biochemical examinations showed slight elevation of serum carcinoembryonic antigen level. The lesion was resected by tail and body pancreatectomy and her postoperative course was uneventful. Seven years and 4 months after the initial operation, however, her serum level of carbohydrate antigen 19‐9 was found to be elevated, and a recurrence of pancreatic cancer was suspected. Examinations revealed a mass in the head of the remnant pancreas. The lesion was radically resected by total remnant pancreatectomy. Histological examinations showed that the initial tumor was a well differentiated tubular adenocarcinoma, while the second tumor was characterized as a moderately differentiated tubular adenocarcinoma. The surgical margins of the distal pancreatectomy specimen were free of atypical cells. Therefore, the position of the second lesion diminished the likelihood that it had developed by intrapancreatic metastasis. This suggests that the second carcinoma in the head of the pancreas may have been a second primary lesion.     

Solitary pancreatic tuberculosis mimicking advanced pancreatic carcinoma

A 40-year-old woman was referred for pancreatic head carcinoma invading the portal vein. The dichotomy between the radiological findings and the general condition of the patient, as well as the laboratory results (no evidence of cholestasis), cast doubt on the diagnosis. There was no history of tuberculosis. The chest radiograph revealed no pathological findings. The anatomic relationships of the lesion entailed a high risk of vascular injury if tissue biopsy were to be done; therefore, diagnostic laparotomy was performed. Biopsy revealed granulomas with caseous necrosis, consistent with tuberculosis. After 6 months of antituberculosis treatment, the lesions had completely resolved. Tuberculosis should be considered in the differential diagnosis of pancreatic masses, particularly in regions where the disease is endemic. The condition usually resembles an advanced pancreatic tumor. Performing a biopsy of inoperable lesions and maintaining a reasonable skepticism in regard to the evaluation of operable lesions (attention to nonexclusive but helpful clues, such as young patient age, history of tuberculosis, absence of jaundice) will lead to the diagnosis in most patients. Diagnostic laparotomy may be required in a small subset of patients. The response to antituberculosis treatment is very favorable. The role of resection (e.g., pancreatoduodenectomy) is very limited.