术前磁共振成像评估壶腹周围癌Whipple手术的价值

Application of preoperative MRI to evaluation of Whipple procedure in patients with Vater periampullary carcinoma

目的探讨磁共振成像技术在壶腹周围癌Whipple手术可切除性中的应用价值。方法对178例拟行Whipple手术的壶腹周围癌患者,术前进行1.5T磁共振平扫加增强扫描,明确肿瘤类型以及肿瘤和周围组织之间的关系,并在此基础上进行综合分析,从而对患者Whipple手术可切除性进行术前评估。结果 178例壶腹周围癌患者中,胆总管下端癌46例(25.8%),壶腹癌37例(20.8%),十二指肠乳头癌7例(3.9%),胰腺癌88例(49.4%);磁共振术前诊断淋巴结转移者59例(33.1%),肝脏转移者17例(9.6%),血管受累者51例(28.7%),明显肝内外胆管扩张者127例(71.3%)。178例患者中,通过磁共振检查评估可手术切除者118例,实际切除者112例;不可切除者80例,实际切除者3例。结论壶腹周围癌的术前磁共振检查对术前指导临床进行Whipple手术具有很高的价值。

Objective To investigate the application of preoperative magnetic resonance imaging （MRI） to Whipple procedure （pancreaticoduodenectomy） in patients with Vater periampulla carcinoma （VPC）. Methods A total of 178 patients with VPC, who were due to be performed Whipple procedure, underwent routine and enhanced scanning of MRI in order that the types of tumor and the relationship between the tumor and surrounding tissue would be clarified. Results Common bile duct carcinoma accounted for 25.8% （ n = 46） , carcinoma of ampulla for 20.8% （ n = 37 ） , duodenal papilla carcinoma for 3.9% （ n = 7 ） , and pancreatic car- cinoma for 49.4% （ n = 88 ）. Moreover, there were 59 （ 33.1% ） patients with lymph node metastasis, 17 （9.6%） with liver me- tastasis, 51 （28.7%） with involved vessels, and 127 （71.3%） with expansion of intra-and extra-hepatic bile duct. By the MRI examination, the tumors were resectable in 118 patients, 112 of whom underwent resection; that were unresectable in 80 ones, but 3 of them underwent resection in the end. Conclusion MRI is of high value in the preoperative direction of the Whipple procedure for VPC.