16层螺旋CT可切除性评估联合解剖性探查技术在胰头癌中的应用价值

Value of Resectability Evaluation by 16-Multislice Helical CT Combining Anatomical Exploration on Surgical the Raply for Patients with Pancreatic Head Carcinoma

目的评价16层螺旋CT可切除性评估联合解剖性探查技术在胰头癌中的应用价值。方法对2004年7月～2005年10月胰头癌手术病例21例做前瞻性研究,作为A组。术前做16层螺旋CT检查,行影像学分期及可切除性评估。术中应用解剖性探查技术,着重胰腺钩突部和肠系膜上血管、门静脉的解剖探查。回顾性分析1997年1月～2004年6月胰头癌手术病例47例做临床对照,作为B组。两组手术结果作比较。结果16层螺旋CT可切除性评估的阳性预测值、阴性预测值分别为83.3%,100%.A组、B组手术切除率、并发症发生率、手术死亡率分别为47.6%,19.0%,0,23.4%,25.5%,2.10%.两组手术切除率差异有统计学意义(P<0.05)。结论利用16层螺旋CT对胰头癌进行影像学分期,可以较为准确地评估其可切除性;联合应用16层螺旋CT可切除性评估、解剖性探查技术对提高胰头癌的手术切除率有肯定意义。

Objective To study the value of preoperative evaluation of resectability by 16-muhislice helical CT combining technique of anatomical exploration on surgical theraphy for patients with pancreatic head carcinoma. Methods Twenty-two consecutive patients with pancreatic head carcinoma were prospectively studied as group A from July 2004 to Oct 2005. All the patients were taken preoperative prediction of reseetability and unresectability based on 16-muhislice helical CT images, then anatomical exploration were performed through operation with focus on pancreas uncinate process,superior mesenteric vein, portal vein（SMV-PV） ,superior mesenteric artery（SMA） ;Forty- seven consecutive patients with pancreatic head carcinoma who had reeevied operation were analyzed retrospectively as group B from Jan 1997 to Jun 2004. Surgical result including resection rate, postoperative morbidity and mortality were then compared between the two groups. Results The positive predictive value of evaluation of resectability by 16-muhislice helical CT was 83.3% , he negative was 100%. Resection rate ,postoperative morbidity and mortality for group A and group B was 47.6% , 19.0% ,0,23.4% ,25.5% ,2.10% respectively, in resection rate, there was a statistical difference（ P 〈 0. 05 ） between the two groups. Conclusion The resectability of pancreatic head carcinoma can be evaluated exactly by 16-muhislice helical CT and the resection rate of pancreatic head carcinoma can be improved significantly by preoperative 16-multislice helical CT evaluation of resectability combining technique of intraoperative anatomical exploration.