胰十二指肠动脉弓移位对胰头-壶腹区肿瘤的鉴别诊断

Value of pancreatic duodenal artery arch shift for differential diagnosis of pancreatic head-ampulla region tumors

目的分析胰头-壶腹区肿瘤与胰十二指肠动脉弓的关系,提高对该区肿瘤组织来源的定性诊断水平。方法收集2009年1月至2018年1月在中山大学附属第一医院术前行64排螺旋CT检查并经病理证实的胰头-壶腹区36例肿瘤,包括胰头癌10例,胰头神经内分泌肿瘤8例,胰头实性假乳头状瘤2例,胰头淋巴瘤1例,十二指肠乳头癌8例,十二指肠淋巴瘤1例,十二指肠间质瘤1例和胆总管癌5例。回顾分析其不同组织来源的肿瘤与胰十二指肠动脉弓的关系。结果胰头来源肿瘤使胰十二指肠动脉弓向右移位,恶性肿瘤对血管有包埋;胆总管来源肿瘤使胰十二指肠动脉弓向右移位,但肿瘤对血管无有包埋;十二指肠壶腹部来源肿瘤使胰十二指肠动脉弓向左右移位,恶性肿瘤对血管无有包埋。结论胰十二指肠动脉弓的移位和包埋征象在胰头-壶腹区肿瘤的CT鉴别诊断中有重要价值。

Objective To analyze the relationships between pancreatic head-ampulla region tumors and pancreatic duodenal artery arch,in order to improve qualitative diagnosis of tumor tissue origin in this area.Methods A total of36cases of pancreatic head-ampulla region tumors which were scanned using multi-slice spiral CT before operation and confirmed by pathology were collected in our hospital from January2009to January2018,including10cases of pancreatic head carcinoma,8cases of pancreatic neuroendocrine tumor,2cases of pancreatic head solid pseudopapillary tumor,1case of pancreatic head lymphoma,8cases of duodenal papillary carcinoma,1case of duodenal lymphoma,1case of duodenal stromal tumor and5cases of common bile duct carcinoma.The relationship between tumor tissue origin and pancreatic duodenal artery arch were analyzed retrospectively.Results Pancreatic head originated tumors pushed the pancreatic duodenal artery arch to the right,with vascular embedding.Common bile duct originated tumors pushed the pancreatic duodenal artery arch to the right,but without vascular embedding.Duodenal ampulla originated tumors pushed the pancreatic duodenal artery arch to the left and right,without vascular embedding.Conclusion The shift and embedding signs of pancreatic duodenal artery arch have improtant value in the CT differential diagnosis of tumors in the pancreatic head-ampulla region.