多层螺旋CT评价侵犯胰周血管的胰腺癌的可切除性

Preoperative evaluation of the resectability of pancreatic cancer with peripancreatic vascular invasion by multi-slice computed tomography

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。

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 laparotomy 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 greatly 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.