术前CT评估胰头癌可切除性的意义

目的评价术前CT判别胰头癌可切除性的方法和标准，并评估其临床意义。方法使用螺旋CT对24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24例胰头癌病人，术前15例判别可切除，实际14例得到了根治性切除，阳性准确率达93．3％，阴性准确率达100％。结论利用血管受侵犯程度分级，螺旋CT可以较准确的判别胰头癌的可切除性，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。     

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。     

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。     

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。     

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。     

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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。     

肠系膜上血管或门静脉受压性胰头部恶性肿瘤根治性胰十二指肠切除术的技巧

目的 探讨肠系膜上血管或门静脉受压性胰头部恶性肿瘤的根治性胰十二指肠切除技巧.方法 在2005年3月至2007年3月,术前采用多排螺旋CT薄层扫描和血管重建技术评估56例肠系膜上血管或门静脉受压性胰头部恶性肿瘤患者的邻近血管是否受侵犯和肿瘤的可切除性;术中运用预置肠系膜上静脉、门静脉、脾静脉三阻断带或四阻断带(附加肠系膜下静脉),以及肠系膜上静脉与肠系膜上动脉交叉牵引下完整切除胰腺钩突部的方法,顺利地完成了56例根治性胰十二指肠切除.结果 术前判断胰腺肿瘤是否侵犯血管和可切除性的准确率分别为98%和100%.56例患者中,37例行三阻断和2例行四阻断后用5-0无创血管缝合线缝合肠系膜上静脉出血点;1例行肠系膜上静脉部分切除修补;手术时间5～8 h;出血量200～600 ml.无术中及术后大出血和胰瘘发生.随访至今,2例患者因肝脏多发性肿瘤转移,分别于术后7个月和9个月死亡.其他54例至今存活良好.结论 术前多排螺旋CT薄层扫描、血管重建技术可较准确地判断胰腺肿瘤是否侵犯血管和是否可根治性切除;采用三阻断或四阻断和肠系膜上血管交叉牵引方法可较顺利地完成肠系膜上血管或门静脉受压性胰头部恶性肿瘤的根治性胰十二指肠切除.     

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     

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.     

腹部医学图像三维可视化系统在胰腺肿瘤诊断和可切除性评估中的作用

目的 研究腹部医学图像三维可视化系统(MI-3DVS)在胰腺肿瘤诊断及可切除性评估中的价值.方法 2008年11月至2009年8月应用MI-3DVS对12例胰腺肿瘤患者的64排螺旋CT扫描数据进行三维重建,对胰腺肿瘤进行辅助诊断及可切除性评估,并与手术所见及病理检查结果进行对照.男性7例,女性5例,年龄14～83岁,平均45岁.其中胰腺癌4例、胰腺实性假乳头状瘤5例、浆液性囊腺瘤2例、胰腺囊肿(导管上皮乳头状增生)1例.结果 12例患者中,术前评估可切除的9例均成功切除肿瘤;2例术前评估不可切除,术中得到证实,仅行姑息手术;未手术1例.3例被外院判为不可切除的胰腺肿瘤患者,三维重建显示巨大肿瘤对相邻大血管为严重压迫,成功切除了肿瘤.结论 MI-3DVS重建对胰腺肿瘤的诊断和可切除性的评估有较高应用价值并具显著临床意义.     

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。     

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。     

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...     

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??Study of quantitative assessment of vascular invasion by pancreatic carcinoma with multi-slice spiral CT TAO Ye*, TIAN Li. *Department of General Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, China
Corresponding author: TIAN Li, E-mail: tianli1954@gmail.com
Abstract Objective To discuss the application value of quantitative assessment of vascular invasion by pancreatic carcinoma with multi-slice spiral CT (MSCT). Methods The essay analyzed 22 cases of pancreatic carcinoma admitted between August 2009 and June 2010 in China-Japan Union Hospital of Jilin University. They had been assessed prospectively and quantitatively with 320-slice spiral CT. Compared the CT scans results with operations, the diagnosis value of MSCT for pancreatic carcinoma was evaluated. Results For the assessment of vascular invasion with MSCT, the sensitivity was 91.2%, and the specificity was 98.7%, and accuracy was 96.4%. When the length and the distance between the invaded vessel and vessel branches were measured, only two vessels were not correctly measured by MSCT. Conclusion MSCT has high accuracy of evaluating the vascular invasion by pancreatic carcinoma, so that it can quantize the degree and range of invaded vessel correctly and it can provide important reference value for diagnosing and treating pancreatic carcinoma.     

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.     

Ultrafast magnetic resonance imaging improves the staging of pancreatic tumors.

OBJECTIVE: This prospective study was undertaken to evaluate the accuracy of a noninvasive "all-in-one" staging method in predicting surgical resectability in patients with pancreatic or periampullary tumors. SUMMARY BACKGROUND DATA: Despite progress in imaging techniques, accurate staging and correct prediction of resectability remains one of the chief problems in the management of pancreatic tumors. Staging algorithms designed to separate operable from inoperable patients to save the latter an unnecessary laparotomy are becoming increasingly complex, expensive, time-consuming, invasive, and not without risks for the patient. METHODS: Between August 1996 and February 1997, 58 consecutive patients referred for operation of a pancreatic or periampullary tumor were examined clinically and by 5 staging methods: 1) percutaneous ultrasonography (US); 2) ultrafast magnetic resonance imaging (UMRI); 3) dual-phase helical computed tomography (CT); 4) selective visceral angiography; and 5) endoscopic cholangiopancreatography (ERCP). The assessment of resectability by each procedure was verified by surgical exploration and histologic examination. RESULTS: The study comprised 40 male and 18 female patients with a median age of 63 years. Thirty-five lesions were located in the pancreatic head (60%), 11 in the body (19%), and 1 in the tail of the gland (2%); there were 9 tumors of the ampulla (16%) and 2 of the distal common duct (3%). All five staging methods were completed in 36 patients. For reasons ranging from metallic implants to contrast medium allergy or because investigations already had been performed elsewhere, US was completed in 57 (98%), UMRI in 54 (93%), CT in 49 (84%), angiography in 48 (83%), and ERCP in 49 (84%) of these 58 patients. Signs of unresectability found were vascular involvement in 22 (38%), extrapancreatic tumor spread in 16 (26%), liver metastases in 10 (17%), lymph node involvement in 6 (10%), and peritoneal nodules in only 2 patients (3%). These findings were collated with those of surgical exploration in 47 patients (81 %) and percutaneous biopsy in 5 (9%); such invasive verification was deemed unnecessary and therefore unethical in 6 clearly inoperable patients (10%). In assessing the four main signs of unresectability (extrapancreatic tumor spread, liver metastases, lymph node involvement, and vascular invasion), the overall accuracy of UMRI was 95.7%, 93.5%, 80.4%, as compared to 85.1%, 87.2%, 76.6% for US and 74.4%, 87.2%, 69.2% for CT. In assessing vascular invasion, the sensitivity, specificity, and overall accuracy of angiography were 42.9%, 100%, and 68.8%, respectively. There were 3 complications (12.5%) after 24 resections, 5 in 17 palliative procedures, and none after 6 explorations only. The hospital stay was 14 days after resection, 13 after palliative bypass, and 6 after exploration alone. There was no operative or hospital mortality in these 58 cases. CONCLUSIONS: Although it is by no means 100% accurate, UMRI is equal or even superior to all other staging methods. It probably will replace most of these, because it provides an "all-in-one" investigation avoiding endoscopy, vascular cannulation, allergic reactions, and x-radiation. But because even UMRI is not perfect, the final verdict on resectability of a tumor still will depend on surgical exploration in some cases.