胰腺癌侵犯胰周主要血管的CT表现分析

目 的分析多层螺旋CT(MSCT)胰腺检查，胰腺癌侵及胰周主要动、静脉的不同CT表现特征。方法 MSCT诊断胰腺癌68例患者中，33例行手术治疗(其中12例行胰十二指肠切除术，21例剖腹探查发现不可切除)，病理结果均证实为胰腺导管细胞癌。术中由手术者仔细探查胰周主要血管[肠系膜上动脉(SMA)、腹腔干(CA)、肝动脉(HA)、肠系膜上静脉(SMV)及门静脉主干(PV)]。结果 165支受检血管中，手术探查发现103支血管未受侵犯，其余62支血管受侵，MSCT术前检查，8．1％(5／62)受侵血管误判为未受侵犯(假阴性)。其余受侵的胰周主要动、静脉(57支)具有不同的CT表现特征：胰周主要动脉受侵时，均被肿瘤包绕大于管周的1／2或完全包埋于肿瘤中。胰周主要静脉受侵时，部分静脉血管被肿瘤包绕小于管周的1／2：SMV为4支(4／17)，PV为2支(2／13)，但同时均出现管壁受浸润或管腔狭窄或管腔形态改变；胰周静脉受侵犯时出现管腔狭窄或闭塞的机会较胰周动脉大：SMV为11支(11／17)，PV为12支(12／13)，而CA为3支(3／8)，HA为4支(4／7)，SMA为4支(4／12)；胰周静脉受侵犯时管壁呈浸润性改变的比例较胰周动脉高：SMV为11支(11／17)，PV为7支(7／13)，而CA为3支(3／8)，HA为2支(2／7)，SMA为6支(6／12)。结论 胰周动、静脉受侵及时，其CT表现具有不同特征。

The CT signs of peripancreatic vascular invasion in pancreatic carcinoma

Objective To analyze various characteristics of multislice spiral CT (MSCT) signs of peripancreatic arterial and venous invasion in pancreatic carcinoma. Methods In 68 patients with pancreatic carcinoma diagnosed by MSCT, 33 patients were confirmed by surgeco-pathology (12 patients underwent pancreaticoduodenectomy, 21 patients were found that the tumors were unresectable during surgical exploration). The peripancreatic major vessels, including superior mesenteric artery (SMA), celiac artery (CA), hepatic artery (HA), superior mesenteric vein (SMV), and portal vein (PV), were examined carefully by surgeons during the operation. Results In surgical exploration, 103 of 165 vessels were found uninvolved, and the other 62 vessels were found invaded by the tumors. Except 5 false-negative vessels, the characteristics of invaded peripancreatic major vessels presented in preoperative MSCT were as follows: all of the invaded peripancreatic major arteries were involved by tumors above one-half circumference of the vessel or embedded in tumors. Parts of the invaded peripancreatic major veins, such as 4/17 SMV and 2/13 PV, were involved by tumors below one-half circumference of the vessels, but venous wall irregularity or vascular stenosis or vascular contour alteration appeared at the same time. The invaded peripancreatic major veins, such as 11/17 SMV and 12/13 PV, more often behaved vascular stenosis or obliteration than the invaded peripancreatic arteries including 3/8 CA, 4/7 HA,4/12 SMA. Irregularity owing to infiltration by tumors appeared more often in the invaded peripancreatic major venous wall (11/17 SMV and 7/13 PV) than in the arterial wall (3/8 CA, 2/7 HA, and 6/12 SMA). Conclusion The CT signs of peripancreatic arterial and venous invasion have different characteristics.