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目的探讨螺旋CT判断胰头癌可切除性的方法和标准。方法上海华东医院2002年1月至2003年9月使用螺旋CT对18例胰头癌病人进行术前薄层多期扫描，将胰周血管受侵犯程度分为4级，结合周围组织脏器的受累情况判断胰头癌的可切除性，并与手术结果相对照。结果18例胰头癌病人，术前9例判断可切除，实际8例得到了根治性切除。准确率达87．5％，不可切除的判断准确率达90％。结论利用血管受侵犯程度分级，螺旋CT可以较准确的判断胰头癌的可切除性，具有重要的临床意义。     

多螺旋CT在胰腺癌切除评估中的价值

目的探讨多螺旋CT判断胰腺癌可切除性的方法和标准。方法使用螺旋CT对22例胰腺癌患者进行术前薄层多期扫描,将胰周重要血管受侵犯程度分为5级,结合周围组织脏器的受累情况判断胰腺癌的可切除性,并与手术结果相对照。结果22例中术前10例判断可切除,实际9例得到根治性切除,准确率达88.9%,不可切除的判断准确率达92.3%。结论根据血管受侵犯分级,多螺旋CT可以较准确的判断胰腺癌的可切除性,具有重要的临床意义。     

血管受侵程度对胰头癌可切除性影响

目的：探讨螺旋CT扫描下不同胰腺周围血管受侵类型及程度对胰头癌可切除性的影响。方法：回顾性分析我院收治的胰头癌患者病例62例,整理患者相关临床资料并根据螺旋CT表现的对胰周血管侵犯的不同影像学特点,对患者进行分类和评估,探讨不同类型胰周血管受侵情况对胰头癌可切除性的影响。结果：本组62例胰头癌病例中,行姑息性手术21例,胰十二指肠切除术41例。对比分析术前CT表现的血管受侵情况和术中探查发现,血管受侵周径分级、血管受压程度分级与血管受侵长度分级具有较高灵敏度、特异度和准确性。三者与临界胰头癌可切除性具有明显相关性,其中血管受侵长度较其余两者相关性更高。结论：螺旋CT对于评价胰头癌对周围血管受侵长度、受侵周径及受压程度具有重要意义,对胰头癌术前可切除性评价具有重要参考价值。     

电子束CT及三维成像对胰头癌可切除性的评价

目的　用电子束CT对胰头癌的可切除性进行术前评价 ,以确定电子束CT对胰头癌分期诊断的应用价值。方法　对 5 7例胰头癌行动、静脉双期扫描或实质期扫描并三维成像 ,术前评价其可切除性 ,并与手术中发现相比较。结果　本组 5 7例胰头癌均被手术探查证实。可根治切除 2 1例 ,行动、静脉双期扫描 32例 ,行实质期扫描并三维成像 2 5例。电子束CT判断胰头癌不能切除的准确率为 94%、可切除的准确率为 71% ,两种扫描方式无差别。结论　电子束CT能较为准确、全面地评价胰头癌的可切除性 ,具有较高的临床应用价值。     

胰头癌与周围重要血管关系的CT分型及在切除性评估上的意义

目的在CT图像上对胰头癌肿块与胰周重要血管之间的关系进行分型，并分析各型胰头癌的可切除性。方法收集51例因胰头癌行开腹手术且术前行螺旋CT或多层螺旋CT胰腺双期扫描的病例，在CT图像上分析病灶与邻近重要血管之间的关系，分为Ⅰ～Ⅴ五型，依据手术及病理结果，判断此种分型在预测肿瘤可切除性的准确程度。结果依据CT影像所见及肿物与周围血管的密切关系将51例胰头癌分为Ⅰ型7例，Ⅱ型8例，Ⅲ型15例，Ⅳ型11例和Ⅴ型10例。全部Ⅰ型和Ⅱ型均可切除且无需行血管切除（其中仅1例Ⅱ型切缘为阳性）；Ⅲ型中有7例可切除（但其中3例同时行静脉切除），余8例未能切除；全部Ⅳ型和Ⅴ型均未能切除。结论Ⅰ型和Ⅱ型者可较为可靠地判断为可切除；Ⅳ型和Ⅴ型者可较为可靠地判断为不可切除；Ⅲ型者部分可切除，部分为不可切除，行静脉切除能提高该型的切除率。     

CT记分对胰头癌可切除性及其难度预测的价值

目的　探讨胰腺CT记分对预测胰头癌可切除性及难度的价值。方法　对近 3年收治的113例胰头癌患者术前进行胰腺CT记分 ,将CT记分分为 4类 :(1)易切除类 (0分 ) ;(2 )难切除类(1～ 5分 ) ;(3 )很难切除类 (6～ 9分 ) ;(4 )不可切除类 (>9分 ) ,并与手术中切除率进行比较。结果　 5 7例术前CT记分为 0～ 6分认为可切除的 ,有 5 5例经手术切除 ,CT预测准确率达 96.5 %。结论　胰腺CT记分能较准确预测胰头癌的可切除性及其难度。     

胰头癌可切除性的术前综合评估

目的探讨术前综合评估在判断胰头癌可切除性中的价值。方法收集2006年1月至2006年11月经解放军总医院手术治疗的56例胰头癌,按手术切除方式分为根治性手术组与姑息性手术组,并对两组病例的临床病理特点、实验室检查、CT影像特征进行回顾性分析。结果56例胰头癌根治性切除20例（36．7％）,姑息性切除组36例（64．3％）,姑息性切除的原因主要是血管侵犯（22例）、远处转移（8例）、侵犯周围器官或腹膜后组织并固定（6例）。两组病例中,根治性切除组的背痛及腹痛发生率较低,临床TNM分期多为I～Ⅱ（P〈0．05）;术前CT影像提示瘤体较小,血管侵犯率低（P〈0．01）。而黄疽、体重下降、肿瘤病理类型、分化程度、胆红素水平、血清肿瘤标记物、胆管及主胰管扩张的差异无统计学意义（P〉0．05）。结论术前综合评估是判断胰腺癌可切除性的有效手段。     

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目的　探讨磁共振三维重建成像在胰头癌可切除性判断中的价值。方法　对2 0 0 0年1月至2 0 0 4年7月间诊断为胰头癌的4 3例病人进行磁共振成像及磁共振三维重建成像检查,并与术中探查结果及手术方式对照。结果　4 3例胰头癌病人根据肿瘤和周围血管的关系分为5级:0级11例,Ⅰ级13例,Ⅱ级15例,Ⅲ级1例,Ⅳ级3例,结合手术结果术前预测肿瘤能否切除正确率达95 .4 %。结论　磁共振三维重建成像结果对预测胰头癌病人手术可切除性、病变程度估计及指导临床治疗有重要价值。     

螺旋CT血管造影在胰头癌手术中的价值

目的 探讨术前螺旋CT血管造影(SCTA)诊断局部进展期胰头癌侵犯胰周大血管在胰头癌手术中的价值.方法 92例横断面CT检查疑似局部进展期的胰头痛病人,术前均进行了sCTA检查,评价胰头癌侵犯血管的情况.根据不同的分级,采取不同的术中探查方式和术式.结果 45例胰头癌病人SMV/PV受侵2级以下,施行了经典胰十二指肠切除术.其中受侵1～2级的12例术中探查证实肿瘤与血管之间是粘连和慢性炎症表现.13例SMV/PV受侵3～4级,长度低于2 cm的,行联合血管切除(PVR)的胰十二指肠切除术,直接端端吻合重建门静脉.而SMV/PV受侵4级,长度2 cm以上的34例,5例行联合PVR的胰头癌切除术,其中胰十二指肠切除术4例,全胰切除术1例,均采用Gore-Tex人工血管植入重建门静脉.其余29例SMV/PV受侵长度3 cm以上,术中探查不可切除,行胆管空肠内引流术,其中6例同时行胃卒肠吻合术.结论 术前SCTA检查可精确诊断胰头癌侵犯胰周大血管的情况,藉此可在术中选择不同的探查方式和术式.     

螺旋CT双期薄层扫描对胰头癌可切除性的评估

目的 探讨螺旋ＣＴ双期薄层增强扫描对胰头癌可切除性的评估价值。方法 回顾性分析２４例经螺旋ＣＴ双期薄层增强扫描胰头癌的ＣＴ表现,观察肿块对邻近器官或组织侵犯情况,以及有无远处器官和淋巴结转移,据此判断肿块能否切除,并将其结果与手术病理结果相对照。结果 螺旋ＣＴ诊断胰头癌可切除的敏感性为９０．９％,特异性为８４．６％,阳性预测值为８３．３％,阴性预测值为９１．７％,准确性为８７．５％。结论 螺旋ＣＴ     

三维可视技术指导腹腔镜胰十二指肠切除治疗胰头癌19例体会

目的评价三维可视化技术指导腹腔镜十二指肠切除治疗胰头癌的可行性与临床价值。 方法回顾性选取2017年1月至2018年8月收治并确诊的19例胰头癌患者的临床资料。其中男11例,女8例;年龄23～79岁,平均(54.3±14.2)岁。其中胰腺导管腺癌15例,胰腺黏液腺癌2例,乳头状癌2例。对患者进行定位二维CT成像,采用三维可视化技术重建二维CT图像,进行术前评估、三维可视化可切除性评估临床分型及其可切除性,并将其与手术中发现进行比较。 结果本组19例患者均经手术探查证实为胰头癌。经三维可视化重建后,19例患者中,可切除性评估为Ⅰ型者4例、Ⅱ型7例、Ⅲ型l例、Ⅳ型3例、Ⅴ型4例,8例评估后行胰腺肿瘤切除;血管解剖变异2例,清晰显示可疑的淋巴结11例,三维重建肿瘤的解剖关系与术中所见相符。 结论三维可视化技术有助于指导胰腺肿瘤患者进行术前可切除性评估,明确肿瘤大小、解剖学变异、肿大淋巴结等,具有一定的优势,值得在临床中推广使用。     

64排螺旋CT血管成像对胰腺癌血管侵犯的评估

目的 探讨64排螺旋CT血管成像在胰腺癌血管侵犯程度及胰腺癌可切除性评估中的价值.方法 对28例胰腺癌病人进行腹部螺旋CT检查,并做二维、三维重建图像.分别按照Loyer分型标准、Lu分级标准及本研究制定的标准评价胰腺周嗣重要血管的侵犯程度,评价胰腺癌是否可切除.以手术结果为金标准,计算各标准对血管可切除性评价的正确率...     

双源CT血管重建对胰腺癌可切除性的评估作用

目的 探讨胰腺癌术前双源CT血管重建评估对手术可切除性及根治性切除率（R0切除）的影响。方法 随机抽取我院2011年1月至2014年12月间行双源CT平扫+增强+血管重建后手术治疗的胰腺癌患者49例,设定为重建组（胰头癌29例,胰体尾癌20例）;另随机选取我院2007年1月至2010年12月间行常规CT平扫+增强后手术治疗的55例胰腺癌患者设定为非重建组（胰头癌33例,胰体尾癌22例）,分析两组的可切除率（所有入组病例均已排除远端转移和周围脏器浸润）;对两组手术切除的患者进一步行R0切除率比较。结果 就胰头癌而言,重建组手术切除率和阴性切缘率分别为82.8%（24/29）和87.5%（21/24）,均显著高于非重建组63.6%（21/33）和76.2%（16/21）（x²=22.41和15.73,P=0.001和0.002）;对于胰体尾癌,重建组手术切除率和R0切除率分别为90%（18/20）和88.9%（16/18）,均显著高于非重建组77.3%（17/22）和76.5%（13/17）（x²=13.1和12.56,P=0.004和0.01）。结论 术前双源CT血管重建能够显著提高胰腺癌手术切除率和R0切除率,值得进一步临床推广。     

Efficacy of computerized tomography in the preoperative staging of pancreatic carcinoma

The increasing use of nonoperative methods for the diagnosis and palliative treatment of pancreatic cancer has placed greater emphasis on computerized tomography (CT) in staging of this malignancy. The present study was done to review our experience with CT in staging pancreatic cancer, specifically its efficacy in predicting lesions amenable to curative versus noncurative surgical treatment. Sixty six consecutive patients with pancreatic cancer who were considered potential candidates for surgical resection and who had preoperative CT scans over the 4-year period from 1982 through 1986 were studied. Preoperative CT scans were reviewed by a radiologist without knowledge of patients' surgical management. CT criteria for unresectable disease include hepatic and distant metastasis as well as evidence of locally advanced disease, including peripancreatic fascial extension, extension of tumor to locally contiguous structures, vascular encasement/invasion, and local lymphadenopathy. CT predicted resectability with a sensitivity of 75 per cent and a positive predictive value of 38 per cent. Unresectability was predicted with a sensitivity of 72 per cent and positive predictive value of 93 per cent. CT incorrectly predicted unresectable disease in three patients who had a curative resection. CT was most reliable when it predicted unresectability due to the presence of hepatic and/or distant metastasis. CT predicted unresectability with least sensitivity using criteria for locally advanced disease. Therapeutic decisions for nonoperative management of patients with pancreatic cancer based upon CT predictions of unresectable disease, especially predictions of unresectability solely on the basis of locally advanced disease, can not be recommended at this time.     

Predicting resectability of periampullary cancer with three-dimensional computed tomography

The radiographic assessment of extent of tumor burden and local vascular invasion appears to be enhanced with three-dimensional computed tomography (3D-CT). The purpose of this study was to evaluate the impact of preoperative 3D-CT in determining the resectability of patients with periampullary tumors. Intraoperative findings from exploratory laparotomy were gathered prospectively from 140 patients who were thought to have periampullary tumors and were deemed resectable after undergoing preoperative 3D-CT imaging. CT findings were compared to intraoperative findings, and the accuracy of 3D-CT in predicting tumor resectability and, ultimately, the likelihood of obtaining a margin-negative resection were assessed. Of the 140 patients who were thought to have resectable periampullary tumors after preoperative 3D-CT, 115 (82%) were subsequently determined to have periampullary cancer. The remaining 25 patients had benign disease. Among the patients with periampullary cancer, the extent of local tumor burden involving the pancreas and peripancreatic tissues was accurately depicted by 3D-CT in 93 % of the patients. 3D-CT was 95% accurate in determining cancer invasion of the superior mesenteric vessels. Preoperative 3D-CT accurately predicted periampullary cancer resectability and a margin-negative resection in 98% and 86% of patients, respectively. For patients with pancreatic adenocarcinoma (n=85), preoperative 3D-CT resulted in a resectability rate and a margin-negative resection rate of 79% and 73%, respectively. The ability of 3 D-CT to predict a margin-negative resection for periampullary cancer, including pancreatic adenocarcinoma, relies on its enhanced assessment of the extent of local tumor burden and involvement of the mesenteric vascular anatomy. Presented in part at the Fourth Americas Congress of the American Hepato-Pancreato-Biliary Association, Miami, Florida, February 27-March 2, 2003. Supported in part by a grant from the Stavros S. Niarchos Foundation.     

螺旋CT和彩色多普勒血流显像检查对胰腺癌可切除性的评估价值

目的 探讨术前螺旋CT(HCT)与彩色多普勒血流显像(CDPI)判断胰腺癌能否行根治性切除的价值.方法 回顾性分析1995年1月至2002年12月川北医学院附属医院收治的114例胰腺癌患者的临床资料.以手术和病理检杳结果为标准评估术前HCT和CDPI检杳对胰腺癌能否行根治性切除的判断价值.采用χ2检验和Fisher确切概率法分析检测结果.结果 114例胰腺癌患者中,109例行HCT检查,97例行CDPI检杳,其中96例行HCT和CDPI联合检查.HCT检查发现肿瘤部位与根治性切除率的关系:胰头癌为45.3%(39/86),胰体尾癌为26.3%(5/19),全胰腺癌为0(0/9),胰头癌根治性切除率高于胰体尾癌(χ2=8.965,P<0.05);肿瘤浸润率和转移率均随肿瘤增大而增加,而切除率降低(z=6.15,5.35,7.18,P<0.01).两种检查方法对胰腺癌可切除性的判断:HCT检查灵敏度为77.8%,特异度为82.2%;CDPI检查的灵敏度为73.3%,特异度为80.6%;联合HCT和CDPI检查的灵敏度为90.6%,特异度为92.4%.HCT、CDPI及联合HCT和CDPI检查的Kappa 一致性检验值分别为0.58、0.52和0.82.结论 HCT与CDPI联合检查能弥补彼此的不足,较准确地判断胰腺癌可切除性.     

The questionable role of computed tomography in preoperative staging of esophageal cancer

The findings of computed tomography (CT) in 18 patients with histologically proven esophageal carcinoma were compared with operative and pathological findings. Computed tomography delineated esophageal lesions in 14 of the 18 patients. In 11 patients, CT scanning was found to be inaccurate in assessing tumor involvement of esophageal lymphatic drainage. Nine patients had no abdominal nodal metastasis demonstrated by CT scan. Operative exploration revealed tumor involvement of celiac or left gastric lymph nodes in all of these patients. Two patients' CT scans demonstrated tumor involvement of celiac and left gastric lymph nodes; at operative exploration, these nodes were enlarged, but they were histologically negative for esophageal carcinoma. Operative exploration changed the preoperative TNM classification in 8 of the 11 patients. Review of these data indicates that surgical exploration continues to be the only reliable method of determining the actual extent and often the resectability of esophageal carcinoma.     

Preoperative evaluation of the mandible in patients with carcinoma of the floor of mouth

Preoperative evaluation of the mandible for invasion by tumor has always been a difficult problem. Various methods have been used, including clinical evaluation, panoramic x-rays, dental films, routine mandible films, bone scans, computed tomographic (CT) scans, and magnetic resonance imaging (MRI) scans. The diagnostic accuracy of these methods has not been totally satisfactory from the clinical standpoint. We compared the diagnostic effectiveness of clinical evaluation, panorex films, and CT scans in 60 patients with carcinoma of the floor of mouth. The relative value of these tests was studied in relation to marginal or segmental mandibulectomy. Our data showed that CT scanning was not very helpful, mainly because of the presence of irregular dental sockets and artifacts. Clinical evaluation was the most accurate, both to determine bone invasion and to decide the type of mandibular resection necessary in association with the primary tumor. Panoramic films were helpful in evaluating the gross extent of mandibular invasion. However, they were not of any help in determining minimal bony invasion or cortical invasion. Even though CT scanning has made a tremendous impact in other areas of head and neck surgery, it is not of much help in making the critical decisions in the type of mandible resection, marginal or segmental, in patients with carcinoma of the floor of mouth. Our experience demonstrates that clinical evaluation is superior in preoperative evaluation of the mandible, and especially in deciding the type of mandible resection.     

腹腔镜超声扫描在判断胰头癌切除中的价值

目的　探讨腹腔镜及其超声扫描技术 (LUS)在判断胰头癌可切除中的价值。方法　对2 2例临床已确诊为胰头癌的病人在剖腹探查手术前 ,采用腹腔镜超声进行前瞻性的肿瘤分期 ,明确肝、腹膜有无微小转移 ,有无局部的血管侵犯 (门静脉、肠系膜上动静脉、主动脉及下腔静脉 )。结果　本组发现肝表面及腹膜转移癌灶 3例 ,肝内转移灶 1例 ,超声引导穿刺证实为胰腺炎 1例 ,从而避免了开腹手术 ,余 17例中 8例发现腹腔、腹膜后及网膜有肿大淋巴结与局部血管或肿瘤本身与局部血管有侵犯 ,其中 2例发现门静脉血栓 ,余 9例提示可以手术切除。 17例病人进行剖腹探查 ,8例成功进行胰十二指肠切除术。结论　腹腔镜超声扫描可以较为准确的判断胰头癌切除的可能性 ,有望成为胰头癌剖腹探查术前有效的检查方法