MRI对壶腹部肿瘤的临床价值

ＭＲＩ对壶腹部肿瘤的临床价值宁波市医疗中心李惠利医院（３１５０４０）鲍生甫，严志龙，梅绍前，何向蕾，缪光胜壶腹部肿瘤因早期缺乏特征性症状，诊断较为困难，且恶性程度高，因而手术切除率低，预后较差。我院自１９９３年６月至１９９５年４月共收治壶腹部肿瘤２６...     

壶腹部肿瘤术前活检的诊断价值

目的探讨壶腹部肿瘤术前活检的诊断价值。方法回顾性分析2000年1月至2009年11月本院收治的53例壶腹部肿瘤患者的十二指肠镜检及活检资料。结果所有患者术前均行十二指肠镜检查并活检。术前活检病理结果 :腺癌20例(37.7%),高级别上皮内瘤变19例(35.8%),低级别上皮内瘤变13例(24.5%),炎性息肉1例(1.9%)。53例患者中47例(88.7%)行胰十二指肠切除术,6例(11.3%)行肿瘤局部切除术。术后病理结果为:腺癌46例(86.8%),类癌1例(1.9%),腺瘤恶变3例(5.7%),腺瘤伴上皮内瘤变3例(5.7%)。结论多数壶腹部癌分化程度高,肿瘤表层活检难以做出正确诊断,肿瘤定性需结合病变形态、大小,必要时行切除活检。     

腹腔镜超声在胰腺壶腹部肿瘤分期诊断和治疗中的价值

目的 评价腹腔镜超声技术(LapUS)在胰腺和壶腹部癌肿分期诊断和治疗中的临床应用价值。方法 自1996年12月～1999年12月连续对46例怀疑胰腺和壶腹部肿瘤病人进行腹腔镜和腹腔镜超声分期诊断。并与术前影像学检查、手术中发现及术后标本病理学检查进行前瞻对比研究。着重检查肿瘤范围、周围血管侵犯、周围淋巴结转移、浆膜浸润和肝、邻近脏器转移;对可疑病变和肿大的淋巴结进行腹腔镜超声引导下穿刺活检。判断肿瘤切除性。结果 46例病人中。LapUS发现肿块性病灶44例,2例阻塞性黄疸确诊为壶腹部结石嵌顿排除肿瘤。44例肿块性病变中41例为恶性肿瘤,3例为炎性病变,肿瘤诊断正确率为93．2％。本组未发生腹腔镜和腹腔镜超声检查有关并发症。结论腹腔镜和腹腔镜超声检查应列为重要的分期诊断工具,剖腹探查前常规应用可明显提高诊断正确率、完善肿瘤分期诊断和可切除性判断。可避免不必要的剖腹探查术。在微创外科诊治中具有重要的临床应用价值。     

超声内镜与CT对胰腺及壶腹部周围肿瘤的术前诊断价值

目的评估超声内镜(endoscopic ultrasonography,EUS)和CT对胰腺及壶腹部周围肿瘤的术前诊断价值。方法回顾性分析33例胰腺及壶腹部肿瘤患者术前EUS、CT资料,与手术探查及术后病理结果对照,从肿瘤大小、部位等角度筛选出影响EUS准确性的因素。结果 EUS在判断胰周脂肪浸润、胆管扩张、胰周脏器侵犯、血管侵犯等方面敏感性、特异性与CT的差异无统计学意义(P>0．05);EUS在胰管扩张及淋巴结转移方面的诊断价值优于CT(P=0．039和P=0．004); EUS判断胰周脂肪浸润和胰周脏器侵及的准确性与肿瘤大小有关(P=0．015和P=0．022),判断胰管扩张的准确性与肿瘤部位有关(P<0．001)。结论 EUS对胰腺及壶腹部周围肿瘤诊断的临床价值很高,结合CT检查有助于加强对患者术前评价的认识。     

ERCP诊断早期胰腺癌体会

ＥＲＣＰ诊断早期胰腺癌体会张光全程泰煦“早期胰腺癌”指既无特异症状，又无特异体征，至今也没有一个特异的检查方法。本院１０余年行ＥＲ－ＣＰ检查２０００例中确定为“早期胰腺癌”７例（０．３５％），其体会介绍如下。临床资料１一般资料：男５例，女２例。年龄３...     

ERCP对壶腹周围癌的早期诊断价值

目的 探讨ERCP对壶腹周围癌的早期诊断价值和合理应用。方法 对我院1997年1月至2002年12月收治的2l例典型的壶腹周围癌患者的临床特点和ERCP检查资料进行回顾性统计分析。结果 所有病例均经剖腹手术和病理检查证实为壶腹周围癌，90．5％的患者出现上腹饱胀不适的时间早于黄疸l～2个月，壶腹周围癌的ERCP直接、间接征象和特征性改变明显。结论 重视壶腹周围癌早期非特异性症状，若B超发现阳性征象，应及时、合理地应用ERCP检查，同时结合CT、MRCP等其他影像学方法以达到早期诊断的目的。     

壶腹部肿瘤诊治现状

壶腹部肿瘤是指发生于十二指肠乳头内胆管、乳头内胰管、胆胰管壶腹或十二指肠大乳头区域的肿瘤 ,其组织学分型与胰腺其他部位的肿瘤相同 ,如1 999年世界卫生组织将胰腺外分泌肿瘤分为良性、交界性 (指粘液性囊腺瘤或者导管内乳头状粘液腺瘤伴中度不典型增生、实性 -假乳头状瘤 )和恶性三大类。在良性肿瘤中 ,又分成浆液性囊腺瘤、粘液性囊腺瘤、导管内乳头状粘液腺瘤和成熟性畸胎瘤等几种 ,在诊治上问题不多 ,主要在于鉴别其良恶性性质。一般在 B超和 CT扫描上可以发现占位性实质或囊性病变 ,并在 B超和 CT扫描引导下对囊肿病变行穿刺抽…     

磁共振胆胰管成像对壶腹部肿瘤诊断的价值

目的 评价磁共振胆胰管成像对壶腹部癌的诊断价值。方法 通过总结23例壶腹部癌的MRCP及MRI影像资料。对磁共振影像诊断与病理学诊断与病理学诊断的符合率进行回顾性分析。结果 磁共振胰管成像的定位诊断率为100%，与病理诊断的符合率也达91.3%。结论 磁共振胆胰管成像是一种非介入性胆胰管成像技术，具有不需要对比剂，无创伤及图像清晰的优点，对壶腹部癌有较高的诊断价值。     

壶腹部癌的诊断和治疗

壶腹部癌的发病率高于胆管下端癌，但远低于胰头癌。据统计，其发病率仅为胰头癌的1／12。近年，随着消化内镜的普及，壶腹部癌的发现率逐渐增加。与胆管下端癌及胰头癌比较，壶腹部癌的预后相对较好，手术切除率高，术后5年生存率为30％-70％，诊断和治疗有其独自的特点。     

壶腹部癌的诊断和治疗

Ampullary cancer is a relatively uncommon cancer,which is often considered to have a best prognosis among periampullary cancers.Preoperative endoscopic uhrasonography and transpapillary intraductal ultrasonography Call provide useful information not only for tumor staging but also for making therapeutic decisions,especially in patients who are appropriate for endoscopic papillectomy.Whipple resection and pylrus preserring panereaticoduodenectomy are considered to be the standard treatment for ampullary cancer.Although transduedenal ampullectomy is regarded as a less-invasive treatment compared with Whipple resection,it has a high morbidity and hish rate of cancer-cell remnant at the resected margin.Endoscopic papiilectomy may be the treatment of choice for selected cases of ampullary cancer. As to unresectable ampullary cancer,the performance of a biliary-enteric bypass is considered routine to solve obstructive ianndice.The decision as to whether to perform gastrojejunostomy in patients without obvious gastroduodenal obstruction secondary to the tumor remains controversial.We believe that prophylactic gastrojejunostomy should be performed routinely when a patient is undergoing surgical palliation for unresectable ampullary cancer.     

胰腺结石并发胰腺癌的临床特征与诊断

目的提高胰管结石并发胰腺癌的诊治水平。方法报告1989～2005年66例胰管结石中并发胰腺癌11例的临床资料。结果男9例,女2例。5例有酗酒史,5例有肠蛔虫史,主要症状为腹痛、背痛、胆道梗阻、黄疸以及消耗症状。BUS,CT,MRCP,ERCP显示胰管扩张或囊性扩大伴有结石及钙化,胰腺肿大,胆管扩张,1例伴胰管内乳头状黏液瘤。结论胰管结石并发胰癌诊断困难,其诊断线索包括:①<50岁的胰管结石症伴症状近期加重者;②伴胆管梗阻与黄疸者;③影像诊断有胰管扩张,结石或钙化者,胆管扩张及胰腺肿大者;④随访胰管空肠吻合术后症状出现恶化者;⑤胰管内乳头状黏液瘤(IPMN)患者伴胰钙化者应警惕胰腺癌的并发。     

23例胰腺少见肿瘤的MDCT诊断并文献复习

目的 探讨胰腺少见肿瘤的MDCT诊断价值。方法 回顾性分析经手术病理证实的23例胰腺少见肿瘤的MDCT资料,并复习有关文献。结果 23例肿瘤中实性假乳头状瘤7例,导管内乳头状黏液癌6例,胰岛素瘤3例,非功能性胰腺神经内分泌癌2例,原发性胰腺淋巴瘤3例,胰腺转移瘤2例。不同肿瘤具有不同MDCT表现。结论 MDCT对胰腺少见肿瘤的诊断及鉴别诊断有重要价值。     

紧密连接蛋白Claudins与胰腺肿瘤关系的研究进展

claudin蛋白作为细胞之间紧密连接结构主要成分,在调节细胞连接与黏附方面发挥了重要的作用.它在不同肿瘤组织中表达的差异性,直接影响到肿瘤细胞的生物学行为.在胰腺来源的肿瘤中,claudin蛋白的特异性表达为肿瘤的诊断与治疗提供了重要的参考依据,此外,claudin蛋白被证实参与了胰腺癌增殖与凋亡的过程.在肿瘤的治疗方面,claudin蛋白介导的靶向治疗同样具有很大的前景.     

Staging and treatment for patients with pancreatic cancer. How small is an early pancreatic cancer?

To determine the tumor size that constitutes early pancreatic cancer, we reviewed and analyzed the English-language and Japanese literature (a total of 25 publications) on small pancreatic cancers less than 2 cm in diameter and/or stage 1 cancers. Reports on in situ carcinoma and intraductal carcinoma of the pancreas were also evaluated. The results were: (1) A total of 302 cases of small pancreatic cancer less than 2 cm in diameter reported at separate institutions were pooled from 15 reports. The rates for patients in stage I and those with no lymph node metastasis averaged 41.7% and 57.9%, respectively. The 5-year postoperative cumulative survival rate (5Y-PCR) was less than 50% in almost all these reports. Similar data were shown in the 7 collective reviews. (2) Another 33 cases of small pancreatic cancer of 1 cm or less in diameter were collected from three reports. The rates for stage I tumor and 5Y-PCR at one institution with two reports were 100% and 100% and the rates in the other report were 85% and 78%, respectively. (3) Twelve cases of in situ carcinoma and intraductal carcinoma of the pancreas were collected from four reports. All of the patients were stage I and were alive with no evidence of tumor recurrence for periods ranging from 6 to 78 months. Small pancreatic cancer less than 1 cm in diameter is better viewed as an early pancreatic cancer, and in situ carcinoma and intraductal carcinoma of the pancreas with minimal invasion to the pancreatic parenchyma may be defined as early pancreatic cancer, regardless of size. Received for publication on July 14, 1997; accepted on Sept. 9, 1997     

经胆胰隔膜切开联合改良胰管支架技术在胆总管结石行ERCP取石困难插管中的应用

目的 探讨经胆胰隔膜切开联合改良胰管支架技术在胆总管结石行ERCP取石困难插管中的应用效果。方法 回顾性分析我院2020年1月至2021年12月间胆总管结石行ERCP取石的困难插管的60例患者的资料,分析比较单纯经胆胰隔膜切开（TPS）及经胆胰隔膜切开联合改良胰管支架技术（TPS+mPS）解决困难插管的效果及术后并发症发生情况。结果 TPS组与TPS+mPS组在性别、年龄、身高、体重、BMI、肝功能等方面比较差异无统计学意义;在插管成功率,一次性取石成功率方面比较差异无统计学意义;TPS+mPS组在外周血WBC（×109/L）水平、术后胰腺炎发生率、总并发症发生率均低于单纯TPS组（P<0.05）。TPS组有2例术后发生消化道出血,TPS+mPS组无出血病例;两组均无穿孔病例发生。结论 经胆胰隔膜切开联合改良胰管支架技术在胆总管结石行ERCP取石困难插管的患者中应用是安全有效的。     

Pancreatic invasion is a prognostic indicator after radical resection for carcinoma of the ampulla of Vater

Sixty-three patients who had undergone pancreatoduodenectomy for carcinoma of the ampulla of Vater were analyzed with respect to tumor extent and prognosis. The postoperative mortality rate was 3% and overall survival rates 3 and 5 years after surgery were 55% and 46%, respectively. pTNM stage did not reflect prognosis after resection in patients at stages 2 and 3, while pancreatic invasion and regional lymph node metastasis clearly reflected prognosis after resection. Of the 26 patients who had no pancreatic invasion, regional lymph node metastasis was seen in only 19%, whereas of the 37 patients with pancreatic invasion, 62% exhibited lymph node metastasis. These factors were significantly correlated (P<0.001). Pancreatic invasion appeared to be an indirect indicator of regional lymph node metastasis. We conclude that, to improve prognosis for patients with pancreatic invasion, extended resection including extended lymphadenectomy, is a preferable additional procedure.     

胰腺囊性肿瘤的诊断与治疗

目的 探讨胰腺囊性肿瘤的诊断与治疗方法.方法 对我院1985年1月至2006年12月间收治的11例胰腺囊性肿瘤的临床资料进行回顾性分析.结果 本组11例中,仅6例术前确诊为胰腺囊性肿瘤,术前误诊为胰腺假性囊肿4例,误诊为胆总管囊肿1例,误诊率为45.4%.行胰头部囊性肿瘤切除术2例,胰体尾部切除和脾切除术3例,囊性肿瘤局部切除术2例.囊肿空肠Roux-Y吻合术3例,囊肿活检,囊腔内置管引流术1例.内引流术后并发胰性腹水1例,全组无手术死亡.结论 提高对本病的警惕性,常规行胰腺B超和CT检查是早期发现本病的有效方法,避免误诊和积极手术切除,可获得较好疗效.     

胃毕Ⅱ式术后肝胆管结石的ERCP诊断和治疗

目的 探讨胃毕Ⅱ式术后肝胆管结石的ERCP检查及治疗。方法 对74例胃毕Ⅱ式术后的病人进行ERCP检查的同时4例经内镜乳头括约肌切开（EST）、2例经内镜乳头气囊扩张术（EPBD）取石。20例择期行胆总管十二指肠吻合术。结果 74例ERCP成功58例（78．4％），失败16例。内镜及择期手术治疗者均无严重并发症。结论 胃毕Ⅱ式术后肝胆管结石者施行ERCP检查成功率较高并有临床意义，内镜或胆总管十二指肠吻合术疗效好。