CT对胰头癌手术切除可行性的评估

作者对３０例胰头癌患者进行了术前ＣＴ扫描评估手术可切除性的前瞻性研究。结果显示；术前ＣＴ判断为可切除的１３例中，有１２例术中证实确能行根治性胰十二指肠切除术，准确率为９２．３％；而术前ＣＴ依据肠系膜上静脉或门静脉受侵，肿瘤过大侵及十二指肠以及肝或肝门淋巴结转移等判为不能切除的１７例均未能施行根治性胰十二指肠切除术，准确率达１００％，表明术ＣＴ检查对头癌能否施行根治性切除手术确有很好的预测价值。     

胆道旁路手术在胰头癌治疗中的应用：（附84例报告）

近年来,胰腺癌的发病率呈上升趋势,据统计,在美国及日本,已居癌症死亡的第四位。而上海、天津的胰腺癌癌死因已由15年前10位以下,上升到第五位。胰腺癌无论在早期诊断和治疗难度上是最棘手的恶性肿瘤之一。胰腺癌首选外科治疗,但胰腺癌外科治疗效果仍不理想。据文献报告:癌瘤切除率在7.2～26.8％,而手术病死率高达25.3～36.5％;五年生存率为2.6～3.3％,术后平均存活时间仅四个月。     

早期胰头——壶腹区肿瘤15例CT分析

随着ＣＴ的问世和扫描技术的提高，胰头－壶腹区肿瘤的诊断有了很大进步，但其早期诊断仍较困难，采用薄层动态扫描发现小胰癌已引起国内外学者的关注。１资料与方法搜集１９９６年—１９９７年之间我院诊为胰头癌、壶腹部肿瘤的１５例病例的早期ＣＴ表现报告，其中男１１...     

胰十二指肠切除术并插管化疗治疗胰头癌

胰十二指肠切除术并插管化疗治疗胰头癌泰安市中医院（泰安市２７１０００）刘广庆刘德华孙喜波１９８８年８月至１９９５年２月，我们对１６例胰头癌患者在行胰头十二指肠切除术的同时，经胃十二指肠动脉插管至肝固有动脉进行化疗，效果满意，现报告如下。１临床资料１．...     

可切除胰头壶腹部癌术中诊断方法比较

对６２例胰、十二指肠切除术者，术中不同方法诊断可切除胰头、壶腹部癌的有效性进行了回顾。胰周淋巴结活检的阳性率为２０％，诊断有效性最低。细针穿刺抽吸活检（ＦＮＡＢ）诊断胰头癌的阳性率为７１．４３％，而胰切取活检阳性率仅为４０％。两者比较，ＦＮＡＢ诊断胰腺癌更有意义。经十二指肠切开活检，结合胆总管刮取活检常能使壶腹部癌的诊断获得满意结果。临床诊断应主要用于术中怀疑胰腺癌，而获得其组织学诊断又有一定困难的病人。文中对避免临床判断失误的要点进行了讨论。     

区域性胰腺切除治疗胰头癌的现状

胰腺癌是常见的消化系统恶性肿瘤。其发病率在我国虽无确切统计,但据沈魁等调查全国１２个省、市、自治区２０家医院的资料表明,胰腺癌入院患者数呈逐年上升趋势。胰腺癌中３／４以上肿瘤发生于胰头。虽然手术切除是胰头癌唯一可获治愈的治疗手段,然临床所遇胰头癌患者大多属中晚期,以胰十二指肠切除（ＰＤ）作为胰头癌的标准术式,手术切除率仅１０％～２５％。即使根治切除,也有５０％以上患者有局部复发。在我国,多数临床资料报道术后５年生存率不足１０％。胰头癌的生物学特性,可较早发生周围淋巴结和神经丛的转移。当胰头癌≤２…     

CT对胰头癌手术切除可行性的评估（附30例报告）

作者对３０例胰头癌患者进行了术前ＣＴ扫描评估手术可切除性的前瞻性研究。结果显示：术前ＣＴ判断为可切除的１３例中，有１２例术中证实确能行根治性胰十二指肠切除术，准确率为９２．３％；而术前ＣＴ依据肠系膜上静脉或门静脉受侵，肿瘤过大侵及十二指肠以及肝或肝门淋巴结转移等判为不能切除的１７例均未能施行根治性胰十二指肠切除术，准确率达１００％，表明术前ＣＴ检查对胰头癌能否施行根治性切除手术确有很好的预测价值。     

胰头癌的根治性切除与适应证

迄今,胰十二指肠切除术依然是胰头癌治疗的主要手段,也是唯一有治愈可能的方法。近年来,由于手术技术和围手术期监护技术的发展,胰十二指肠切除术的并发症发生率和围手术期死亡率均有较大幅度的下降,大型医疗中心和专科医院的手术死亡率低于5％,并发症发生率低于30％,     

胰头十二指肠切除加胰十二指肠下静脉插管化疗治疗胰头癌：附10例报告

胰头十二指肠切除加胰十二指肠下静脉插管化疗治疗胰头癌（附１０例报告）刘广庆，孙喜波，刘令锁，李仕金，亓空明，王金勇我们自１９８９年６月～１９９４年３月对能切除的胰头癌１０例在行胰头十二指肠切除的同时经胰十二指肠下静脉插管至肠系膜上静脉化疗，效果满意，...     

胰头癌外科治疗的进展

胰腺癌的发病率逐年增加，目前已成为较常见的消化系统肿瘤。胰腺癌的发生部位一般以胰头部为最多见，占70％～75％。二十年前，绝大多数胰腺癌病人在确诊时已不能手术。而少数能手术者，多数肿瘤不能切除。在能切除的少数人中，25％的病人在离开医院之前死亡，其余的也多在18个月内死亡。近年来，由于CT、B超、MRI，肿瘤标志物的应用等诊断方法的改进，麻醉，生命监护的改进，手术经验的积累，并发症的处理，明显改善了胰腺癌病人的预后。在80年代胰十二指肠切除术的手术死亡率由20％降至5％，并且仍有继续下降之趋势。近年来报道手术死…     

多种MR成像技术在胰腺癌诊断及其可切除性探讨

目的 探讨多种MR成像技术对胰腺癌诊断及其手术可切除性判断的价值。 方法 18例经手术和/或病理证实的胰腺癌患者进行了磁共振检查,采用的磁共振序列分别为:GRE T_1WI,TSE T_2WI,脂肪抑制GRE T_1WI,延迟增强GRE T_1WI,磁共振胰胆管造影(MRCP)和三维动态对比增强MRA(3D DCE MRA)。肿瘤累及胰周血管根据程度依次分为0～4级。 结果 18例胰腺癌肿瘤病灶,在GRE T_1WI上均呈稍低信号,TSE T_2WI上均呈稍高信号。脂肪抑制GRE T_1WI上所有肿瘤均呈明 显低信号,延迟增强GRE T_1WI上肿瘤表现环形不规则强化14例,均匀强化4例,但均低于正常胰腺强化。MRCP显示胆总管与主胰管均扩张表现为典型“双管征”8例。在3D DCE MRA上,根据肿瘤与血管周径接触面>1/2为不能切除的标准,则门静脉受累56％(10/18),脾静脉受累39％(7/18),肠系膜上静脉受累67％(12/18),腹腔干及主要分支受累22％(4/18)及肠系膜上动脉受累17％(3/18)。MRI判断2例可完全手术切除,与手术结果相符。 结论 MRI快速扫描序列、脂肪抑制技术、MRCP及3D DCE MRA四大MR成像技术的综合应用能提供胰腺癌诊断及手术可切除性判断的必需信息,可以达到一步到位的诊断目标。     

Value of CT criteria in predicting survival in patients with potentially resectable pancreatic head carcinoma

BACKGROUND AND OBJECTIVE: Survival is often poor after resection of pancreatic tumors. We correlated the pre-operative CTs with survival to find criteria that have prognostic value. To establish the prognostic value of CT in patients with potentially resectable pancreatic head carcinoma. METHODS: In 71 consecutive patients with potentially resectable pancreatic head carcinoma, prognostic factors on CT were scored, for example, tumor size, peripancreatic infiltration, grades of vascular encasement, and local irresectability. All patients underwent surgical exploration. CT findings were compared with results of surgery and histopathology. Prognostic factors for resected and unresected tumors were analyzed using single and multivariate analysis. RESULTS: Forty-one of 71 tumors were resected (24 radical). The sensitivity, specificity, and positive predictive value of CT for surgical irresectability were 0.67, 0.63, and 0.57, respectively. For a non-radical resection, these were 0.62, 0.75, and 0.83, respectively. The median survival was 21 months for resectable tumors and 9.7 months for unresectable tumors. For resected tumors, a tumor diameter of > 3 cm (relative hazard 3.8) and CT signs of local unresectability showed a poor survival. The median survival of resected tumors <2 cm was nearly 30 months. CONCLUSION: CT signs of local irresectability and a tumor diameter of >3 cm predict a poor survival after resection.     

18F-FDG PET/CT与增强CT对胰腺癌可切除性评估价值分析

目的:探讨18F-FDG PET/CT与增强CT对胰腺癌可切除性评估价值。方法:回顾性分析病理、术中所见或临床综合及随访资料证实的胰腺癌病人18F-FDG PET/CT和增强CT影像资料,对比二者及二者联合对胰腺癌可切除性评估价值。结果:74例病人中24例进行了手术,其中仅15例成功完整切除了肿瘤,另9例因术中发现不可切除因素而行姑息手术。余50例均经随访证实因多发转移而不可切除。以不可切除为阳性指标,18F-FDG PET/CT显像对不可切除评估的灵敏度、特异性及准确性分别为79.66%,86.67%和81.08%,增强CT的灵敏度、特异性及准确性分别为84.75%,93.33%和86.49%,二者差异无显著性。以其中一种方法阳性即认为不可切除,二者联合判断的灵敏度、特异性及准确性分别为91.53%,86.67%和90.54%,显著优于单独PET/CT或增强CT。结论:18F-FDG PET/CT与增强CT均为胰腺癌可切除性评估重要手段,二者价值相似,具有互补性,联合应用准确性更高。     

超声内镜对胰腺癌可切除性评估的价值分析

目的探讨内镜超声检查术(EUS)对胰腺癌的可切除性评估的价值。方法收集在术前均经EUS、BUS以及CT检查,后经手术治疗,并最终为病理组织学证实为胰腺癌的病例。对EUS在术前对胰腺癌的可切除性评估进行回顾分析,以手术结果为金标准进行对比,并与BUS以及CT诊断结果进行比较。结果21例接受手术治疗,其中6例术前EUS认为可切除,实际术中切除5例,EUS评估胰腺癌可切除性的准确度为83.3%;15例术前EUS评估为不可切除,实际手术无法切除14例,EUS评估不可切除准确度为93.3%。提示EUS术前评估结果与手术结果一致性较好。EUS诊断胰腺癌准确率为95.2%,CT为90.5%,B超为71.4%。结论应用EUS评估胰腺癌的可切除性是一种有效的方法。     

Assessment of Resectability of Pancreatic Carcinoma by Endoscopic Ultrasonography

OBJECTIVE To study the value of endoscopic ultrasonography (EUS) in the preoperative assessment of resectability of pancreatic carcinoma. METHODS Thirty-eight non-selected consecutive patients were prospectively investigated using EUS to determine tumor resectability. The EUS findings in each of the patients were evaluated prospectively by 2 EUS specialists. All patients were explored and resectability determinded.RESULTS Ten out of 38 cases with pancreatic carcinoma were considered to be resectable by EUS with a positive predictive value of 80% compared to findings with surgery. EUS also had a high correlation with surgical results in assessing unresectability of pancreatic carcinoma, the negative predictive. value was 96.4%. There were 2 false-positive and 1 false-negative assessments (sensitivity, 88.9% and specificity, 93.1%). The accuracy of EUS was the highest. The diagnostic accuracy of EUS, CT, MRI and sonography were 97.4%, 94.6%, 89.5%, and 73.6% respectively. CONCLUSION Endoscopic ultrasonography is an effective method to assess resectability of pancreatic carcinoma.     

胰头癌手术切除可能性的术前评价

目的　通过总结胰头癌病人的临床表现和影像学检查结果来评价手术切除的可能性。方法　总结 3 2例胰头癌病人的临床表现和CT、磁共振 (MR)检查结果 ,判断肿瘤是否已发生邻近浸润或远处转移 ,以此来评价其手术切除的可能性。结果　在 2 2例作CT检查的病例中 ,判断正确的为 17例 ,准确率为 77.3 %。作MR检查 9例 ,全部判断正确 ,准确率为 10 0 %。结论　某些特殊的临床表现和CT、MR检查对判断肿瘤是否发生邻近浸润或转移有较大价值 ,为术前评价手术切除的可能性提供依据。     

^（18）F-FDG PET/CT与增强CT对胰腺癌可切除性评估价值分析

目的：探讨18F-FDG PET/CT与增强CT对胰腺癌可切除性评估价值。方法：回顾性分析病理、术中所见或临床综合及随访资料证实的胰腺癌病人18F-FDG PET/CT和增强CT影像资料,对比二者及二者联合对胰腺癌可切除性评估价值。结果：74例病人中24例进行了手术,其中仅15例成功完整切除了肿瘤,另9例因术中发现不可切除因素而行姑息手术。余50例均经随访证实因多发转移而不可切除。以不可切除为阳性指标,18F-FDG PET/CT显像对不可切除评估的灵敏度、特异性及准确性分别为79.66%,86.67%和81.08%,增强CT的灵敏度、特异性及准确性分别为84.75%,93.33%和86.49%,二者差异无显著性。以其中一种方法阳性即认为不可切除,二者联合判断的灵敏度、特异性及准确性分别为91.53%,86.67%和90.54%,显著优于单独PET/CT或增强CT。结论：18F-FDG PET/CT与增强CT均为胰腺癌可切除性评估重要手段,二者价值相似,具有互补性,联合应用准确性更高。     

CT of pancreatic gas gangrene

A case of gas gangrene complicating acute pancreatitis is presented. The presence of gas within the pancreatic bed is very suggestive of infection with gas forming organisms in the right clinical setting.     

Clinical significance of midkine expression in pancreatic head carcinoma

Midkine (MK) is a heparin-binding growth factor and a product of a retinoic acid-responsive gene. Midkine is overexpressed in many carcinomas and thought to play an important role in carcinogenesis. However, no studies have been focussed on the role of MK in pancreatic carcinoma. This study sought to evaluate the clinical significance of MK expression in pancreatic head carcinoma, including the relationship between immunohistochemical expression and clinicopathologic factors such as prognosis. Immunohistochemical expression of MK and CD34 was evaluated in pancreatic head carcinoma specimens from 75 patients who underwent surgical resection. Midkine was expressed in 53.3% of patients. Midkine expression was significantly correlated with venous invasion, microvessel density, and liver metastasis (P=0.0063, 0.0025, and 0.0153, respectively). The 5-year survival rate was significantly lower for patients positive for MK vs patients negative for MK (P=0.0073). Multivariate analysis revealed that MK expression was an independent prognostic factor (P=0.0033). This is the first report of an association between MK expression and pancreatic head carcinoma. Midkine may play an important role in the progression of pancreatic head carcinoma, and evaluation of MK expression is useful for predicting malignant properties of pancreatic head carcinoma.