螺旋CT结合CA19—9在胰腺癌可切除性评价中的应用

Spiral CT combined with CA19-9 ： value of preoperation in predicting resectability for pancreatic carcinoma

目的探索螺旋CT双期扫描与CA19—9检测相结合在胰腺癌术前可切除性评价中的应用价值。方法回顾分析2002年2月至2006年2月本院52例胰腺癌患者的临床资料，根据螺旋CT双期扫描结果和血清CA19—9检测结果进行胰腺癌术前可切除性评价。结果CT判断胰腺癌不可切除的准确率为100％，而判断可切除的准确率为73．30％。随着胰腺癌浸润程度的进展，CA19-9水平有增高的趋势。局部侵犯组CA19—9均值与可切除组和转移组CA19—9均值差异无统计学意义。以CA19—9大于150U／ml作为不可切除判断的临界值，在不可切除组41例患者中，只有10例患者的血清CA19—9水平大于150U／ml，占24．39％。结论血清CA19-9水平随胰腺癌浸润进展程度有逐渐升高的趋势，但CA19—9水平并不能反应胰周大血管受侵犯。CA19—9检测与CT结合在胰腺癌术前可切除性评价中的临床实用价值有限。

Objective To investigate the value of spiral computed tomography （CT） combined with CA19-9 in predicting the reseetability of patients with pancreatic carcinoma. Method Preoperative clinical features and serum CA19-9 levels of 52 patients with pancreatic cancer between February 2002 and February 2006 were reviewed. Preoperatively respectability was evaluated retrospectively from a complete history and CT imaging. Patients were divided as resectable group （A）, unresectable wlth invasion into large vessels group（B） ,unresectable with metastasis group（C）. Results For prediction of unresectabiliy, spiral CT had accuracy of 100% ,and for prediction of resectability , the accuracy was 73, 30%. The level of serum CA19-9 increased along with advancing of tumor, and serum CA19-9 between group A and group C was significanlly different （P 〈0.05） ,but no differences between group B and group A, group B and group C （P 〉0.05）. If using CA19-9 level of 150 U/ml as a threshold to determine unresectability,among 41 patients of group B and C,only 10 （24.39%） patients had CA19-9 level higher than 150 U/ml. On the other hand,patients of group A had serum CA19-9 level lower than 150 U/ml. Conclusion The level of serum CA19-9 increases along with advancing of tumor, but the level of serum CA19-9 can not reflect tumor local invasion. Application of spiral CT combined with CA19-9 in predicting resectability for the pancreatic carcinoma is limited.