胰腺CT可评估腹腔镜胰十二指肠切除术治疗胰头恶性肿瘤的效果

目的  探讨腹腔镜胰十二指肠切除术对治疗胰头恶性肿瘤的效果，分析手术前后胰腺影像学特点。方法  选取本院2020年1月~2021年6月收治的胰头恶性肿瘤患者110例，按手术方法的不同将患者分为两组，观察组：采用腹腔镜十二指肠切除术(n=61); 对照组：采用开腹十二指肠切除术(n=49)。分析两组患者围手术期指标、手术切除的完整性、炎性反应，并发症的发生率、术前与术后胰腺影像学特点。结果  两组患者手术时间、手术切除的完整性及并发症的发生率差异无统计学意义(P > 0.05)，观察组术中出血量和住院时间均低于对照组，差异有统计学意义(P < 0.05); 观察组血清C-反应蛋白、白介素-6、肿瘤坏死因子-α水平低于对照组(P < 0.05); 术前CT显示胰头部可见不规则囊状低密度影，边缘分叶、内分隔、密度欠均匀，增强边界较清楚，术后有患者可见术区范围包裹性积液、局部密度稍高。结论  腹腔镜胰十二指肠切除术治疗胰头恶性肿瘤可以减轻机体炎性反应，降低术中出血和缩短住院时间，其手术切除的完整性与开腹手术相当，且借助CT术前影像能有效指导手术过程和识别术后胰瘘等并发症。

Effect of laparoscopic pancreaticoduodenectomy for pancreatic head malignant tumor and imaging analysis of pancreas before and after operation

  Objective  To investigate the effect of laparoscopic pancreaticoduodenectomy in the treatment of pancreatic head malignant tumor, and analyze the imaging characteristics of pancreas before and after operation.  Methods  A total of 110 patients with pancreatic head malignant tumor treated in our hospital from January 2020 to June 2021 were selected. They were divided into 2 groups according to different surgical methods. Among them, 61 patients in the observation group were treated with laparoscopic duodenectomy, and 49 patients in the control group were treated with open duodenectomy. Perioperative indicators, surgical integrity and inflammatory response of patients in the two groups were observed. The incidence of complications, preoperative and postoperative pancreatic imaging characteristics were analyzed.  Results  There were no statistically significant differences in the operative time, the completeness of surgical resection and the incidence of complications between the two groups (P > 0.05). The amount of intraoperative blood loss and length of hospital stay were significantly shorter than those in the control group, with statistically significant differences (P < 0.05). The serum levels of C-reactive protein, IL-6 and TNF-α in observation group were significantly lower than those in control group (P < 0.05). Preoperative CT showed irregular cystic low-density shadow on the head of the pancreas, with lobed edges, internal separation, uneven density and clear enhanced boundary. After surgery, patients had encapsulated effusion in the operation area and slightly higher local density.  Conclusion  Laparoscopic pancreaticoduodenectomy in the treatment of pancreatic head malignant tumor can reduce inflammatory response, reduce intraoperative bleeding and shorten hospital stay. The integrity of surgical resection is similar to that of open surgery, and the preoperative CT images can effectively guide the surgical process and identify postoperative pancreatic fistula and other complications.