术前胰腺平扫CT值可预测胰十二指肠切除术后胰瘘危险性

Preoperative pancreas plain scan CT value for the evaluation of the risk of postoperative pancreatic fistula

目的研究术前胰腺体部拟断面平扫cT值同胰十二指肠切除术后胰瘘危险性的关系。方法回顾性分析2010至2012年间87例行端侧胰管空肠黏膜-黏膜吻合法胰十二指肠切除术患者的临床和影像学资料。将胰瘘组与非胰瘘组患者及不同胰瘘严重程度组患者的胰体cT值及胰腺／腹主动脉cT值进行比较。结果87例患者中出现胰瘘共17例，胰瘘发生率为19．5％，胰瘘组的胰腺cT平均值为（37．3±3．5）HU，较非胰瘘组cT值（42．5±3．7）HU明显降低（t=5．328，P=0．000），且胰腺cT值与胰瘘严重程度分级存在明显相关性（r=-0．832，P=0．000）。结论术前胰腺平扫cT值能间接反映胰腺组织学情况，可作为评估术后胰瘘发生危险性的指标之一，同时也能为术中胰肠吻合方式的选择提供有意义的参考信息。

Objective To study the relationship between the preoperative plain scan CT value of the panereas and the risk of postoperative pancreatic fistula （PF）. Methods The clinical and medical imaging data of 87 cases undergoing pancreaticoduodenectomy （ PD ） using duct-to-mucosa pancreaticojejunostomy in our hospital from 2010 to 2012 were reviewed retrospectively. The pancreatic CT value and the CT value ratios of pancreas/abdominal aorta was measured and compared between PF group and non-PF group. Results There were 17 PF cases in all 87 patients, the PF rate was 19. 5% ,Compared with non-PF group in whom the mean pancreatic CT value was （42. 5 -＋ 3.7） HU , the plain scan pancreatic CT value in PF group （37. 3 ＋ 3.5 ） HU was significantly lower （P = 0. 000）. Also, pancreatic CT value is correlatively lower in severe grade PF group patients than those in less severe grade PF group（ r = 0. 832 ,P = 0.000）. Conclusions The preoperative plain scan pancreatic CT vaule can indirectly reflect the histological condition of pancreas and thus may become a useful index to evaluate the risk of postoperative pancreatic fistula after pancreaticoduodenectomy. It can also provide useful information to the surgeons while deciding pancreaticojejunostomy methods during the operation.