CAJ | 학술논문

目的探讨多层螺旋CT(MSCT)评价侵犯胰周血管的胰腺癌的可切除性.方法收集经手术病理证实的胰腺导管细胞癌66例,根据MSCT所示的胰腺癌肿块与胰周血管之间的关系(累及血管周长、血管变形和狭窄的程度、累及血管纵轴的长度),预设五组指标判断胰周血管侵犯时胰腺癌的可切除性,计算各组指标的敏感性、特异性、准确性、假阴性、假阳性、阳性预测值及阴性预测值,并比较各组之间的差异.结果本组中行胰头十二指肠切除术(Whipple)30例,胰体尾切除17例,内引流17例,剖腹探查2例.手术探查无血管侵犯34例,血管侵犯32例.与手术病理结果对比,第一组各项指标均为优,第二组、第三组及第五组的假阴性或假阳性较高,第四组的敏感性及准确性大大低于第一组.结论综合血管受侵的周长、血管变形或狭窄程度及血管纵轴受累的长度,MSCT可用于术前评价胰腺癌的可切除性.
목적 탐토다층라선CT(MSCT)평개침범이주혈관적이선암적가절제성.방법 수집경수술병리증실적이선도관세포암66례,근거MSCT소시적이선암종괴여이주혈관지간적관계(루급혈관주장、혈관변형화협착적정도、루급혈관종축적장도),예설오조지표판단이주혈관침범시이선암적가절제성,계산각조지표적민감성、특이성、준학성、가음성、가양성、양성예측치급음성예측치,병비교각조지간적차이.결과 본조중행이두십이지장절제술(Whipple)30례,이체미절제17례,내인류17례,부복탐사2례.수술탐사무혈관침범34례,혈관침범32례.여수술병리결과대비,제일조각항지표균위우,제이조、제삼조급제오조적가음성혹가양성교고,제사조적민감성급준학성대대저우제일조.결론 종합혈관수침적주장、혈관변형혹협착정도급혈관종축수루적장도,MSCT가용우술전평개이선암적가절제성.
Objective To evaluate the MSCT manifestations and the resectability of pancreatic cancer with peripancreatic vascular invasion preoperatively. Methods The preoperative MSCT imagings of sixty-six cases of patients with pancreatic duct cell carcinoma confirmed by surgical pathology were studied. Based on correlation of pancreatic mass with peripancreatic vessels in MSCT, five grades were defined for the circumferential contiguity, and for vascular deformation or stenosis; two grades for the involved length of the vascular long axis. Five criteria were synthesized on the mentioned grades for detecting peripancreatic vascular invasion and predicting tumor resectability. Compared with surgical and pathologic findings, the sensitivity, specificity, accuracy, false negativity, false positivity, positive predictive value and negative predictive value of each criterion were calculated respectively. The differences between these five criteria were analyzed statistically. Results 44 neoplasms were located in the head of the pancreas, 22 involved the body and the tail of the pancreas. Whipple' s operation was performed in30 cases, pancreatic body and tail was resected in 17 cased, internal drainage and laparotumy were performed in 17 cases and 2 cases respectively. 34 cases were diagnosed as free of tumor invasion to peripancreatic vessels, and 32 cases as invaded by tumor. Compared with surgical and pathologic findings, the sensitivity, specificity, accuracy, false negativity, false positivity, positive predictive value and negative predictive value for predicting vascular invasion and tumor resectability respective were 90.63%, 94.12%, 92.42%, 9.40%, 5.88%, 93.55%, 91.43% in the first group. For the second group, third group and fifth group, the rates of the false negativity or false positivity were higher than the first group. The sensitivity and the accuracy of the fourth group were gready lower than the first group. Conclusion In consideration of the tumor contiguity to the circumference of vessels, the degree of vascular deformation and stenosis, and the involved length of the vascular long axis on MSCT, the assessment accuracy of vascular invasion and respectability may be increased in clinic practice.