增强CT、选择性血管造影对胰腺癌手术不可切除性的评估

Assessment of Unresectability of Pa ncreatic Carcinoma by Enhanced-CT and Selective Angiography

背景与目的:胰腺癌手术不能切除的主要原因是胰周大血管受侵,本文旨在探讨增强CT、选择性血管造影(selectiveangiography,SAG)评估胰腺癌手术不可切除性的可靠性。方法:回顾性分析我院自1996年8月7日～2000年8月12日期间收治的经手术探查证实为胰腺导管腺癌患者67例,其中胰头癌63例,胰体尾癌4例;术前行增强CT、SAG者分别为31、54例。根据具体的判定指标,由手术医师对患者术前CT或SAG片中胰周大血管的受侵程度进行评估(放射医师的报告作为参考),评估结果与术中血管的实际受侵情况比较,评估上述方法的可靠性。结果:31例行增强CT检查者中,CT提示不可切除者13例,手术证实不可切除者12例,预告值为91%。54例行SAG者中,造影提示不可切除者28例,手术证实不可切除者23例,预告值为82%。增强CT和SAG对于评估胰腺癌不可切除的敏感性、特异性、阳性预告值分别为60%、91%、92%和77%、79%、82%。增强CT和SAG联合评估胰腺癌不可切除的敏感性、特异性、阳性预测值分别为91%、100%、100%。结论:增强CT、SAG作为非手术技术手段是术前评估胰腺癌不可切除性的可靠方法,两种方法联合使用可提高预测的敏感性、特异性和阳性预告值。

Background &Objective:One of the major limitations of curative resection in the patients with pancreatic cancer is local tumor extension to the major vessels surrounding pancreas.Therefore the assessm ent of the involvement of major arteries surro unding pancreas by tumor before operation is very important for the judge ment of respectability of pancreatic carcinoma.This study was designed to asse ss the clinical value of contrast-en hanced CT(CECT)and selective angiography(SAG)in predicting the unresectability o f patients with pancreatic cancer.Method:From Aug 7,1996to Aug 12,2000,67patients with pancreatic ductal adenocarcioma pr oved patholgically were retrospectively analyzed.Of these patients,31and 54patients were treated with CECT and SAG,respectively.The involvement of major vessels surrounding pancreas in CECT and SAG were assessed by operator according to specific criterias,which were co mpared with finding in operation.Finally,the a ccuracy of the method was assessed.Result:Among 31cases who were treated with CECT,13were judged unresectable by CECT;and 12were found unresectable during operation,with predict valu e of91%.Among 54cases who were treated w ith SAG ,28were judged unresectable by SAG;and 23were found unresectabl e during operation,with predict valu e of 82%.The sensitivity,specificity,and predict value of CECT and SAG w ere 60%,91%,92%,and 77%,79%,82%,respectively.The sensitivity,specificity,and predict value of CECT combined with SAG were 91%,100%,100%,respectively.Conclusion:Enhanced CT and SAG are useful in assessing the unresectabilty of pancreatic carcinoma,the combination of two ways can improve the sensitivity,specificity and pr edict value.