超声观察原发性胰腺癌引流区转移淋巴结

Ultrasonographic observation on characteristics of the lymph node metastases of primary pancreatic cancer in draining regions

目的探讨原发性胰腺癌引流区转移淋巴结的分布特点及彩色多普勒超声表现。方法经手术病理诊断为胰腺癌的患者21例,均经增强CT、手术或病理诊断有胰腺周围淋巴结转移,以患者胰腺引流区淋巴结的短径≥1.0cm为可疑淋巴结转移,结合彩色多普勒超声图像将原发灶分为胰头癌和胰体尾癌两类,分别统计其可疑转移淋巴结出现的部位,并观察大小、数目、形态、血供特点等。结果本组21例胰腺癌患者的彩色多普勒超声图像中,共计43个部位观察到转移淋巴结;随原发部位不同,引流区淋巴结转移灶的超声显示率也有差别;彩色多普勒超声较易显示腹腔干、肝十二指肠韧带、肠系膜根部、腹主动脉及下腔静脉周围淋巴结转移灶;转移淋巴结多呈圆形及类圆形低回声包块,融合多见,边界欠清,皮质回声偏高不均质,淋巴门偏心或消失;彩色多普勒显示血流信号分布不规则,非淋巴门处可见穿支血管。结论彩色多普勒超声能够较准确地发现原发性胰腺癌的淋巴结转移情况。

Objective To investigate the distributive features and ultrasonographic characteristics of the lymph node metastases of primary pancreatic cancer in lymphatic draining regions. Methods Twenty-one patients with primary pancreatic cancer diagnosed pathologically were involved in this study, and the lymph node metastases in draining regions were verified with operation and pathology. The lymph node in draining regions was recognized as metastasis when its short axis was 1.0 cm on ultrasongraphic image. All patients were divided into two groups according to the primary region, i.e. head and proeessus anconaeus, body and tail of pancreas. The regions of the lymph node metastases were recorded respectively, and the size, number, form and blood supply of the lymph node were observed. Results Lymph node metastases were observed in 43 regions in 21 patients, and the region of primary cancer had effect on the rate of ultrasonographic findings. Lymph node metastases were easy to find with ultrasonography when located around celiac trunk, duodenohepatic ligament, radix of mesentery and abdominal aorta inferior vena cava. Lymph node metastases appeared as round or approximately round hypoechoic masses with unclear border, mostly mixed together, the cortex appeared hyperechoic and uneven, and the hilums were eccentric or disappeared. Blood signals distributed irregularly and the perforating vascular branches were observed out of the lymphoid hilums. Conclusion Color Doppler ultrasound can indicate the information about the lymph node metastases of primary pancreatic cancer relatively accurately.