胰腺癌及壶腹周围癌侵犯门静脉系统的CT诊断及治疗

CT Diagnosis on Pancreatic and Peri-ampullar Carcinoma with Invasive Portal Vein

目的 探讨胰腺癌、壶腹周围癌与门静脉 (PV)系统的关系 ,制定正确的手术方案 ,提高手术切除率。方法 对我院 1995～ 2 0 0 2年所收治的 2 1例胰腺癌和壶腹周围癌患者的临床资料进行回顾性分析。结果 术前采用CT检查诊断PV系统未受肿瘤侵犯 14例 ,受肿瘤侵犯 7例。 17例术前CT检查结果与手术探查结果相符 ,准确率 80 9%。本组中 10例能手术切除 ,3例做了PV壁部分切除整形缝合术。结论 胰腺癌、壶腹部周围癌术前通过CT检查 ,明确肿瘤与PV系统的关系 ,肿瘤未侵犯PV系统和PV系统有微小肿瘤侵犯 ,血管内膜未受侵犯或血管能与胰腺分离者 ,可手术切除。血管被肿瘤包埋 ,明显的血管狭窄或闭塞 ,肿瘤累及肠系膜上动脉 (SMA)或腹腔干近侧 ,肿瘤侵犯PV系统血管内膜或血管内肿块 ,均列为手术禁忌。

Objective To study the relation between the pancreatic and peri-ampullar carcinoma and portal vein (PV) to make a relevant surgical procedure and to enhance the resecable rate of pancreatic and peri-ampullar carcinoma. Methods A respective analysis of 21 cases of pancreatic and peri-ampullar carcinoma patients was made. Results There were 14 cases without PV invaded before operation on CT and 7 cases with PV invaded. The results of CT examinations were as same as those of the operation exploration with the accuracy of diagnosis being 80.9%. In this group, 10 cases underwent operation resection and 2 partial resection of PV wall and plastic operation. Conclusion Preoperative examination of CT to the patients with pancreatic and peri-ampullar carcinoma could understand the relation between the tumors and PC. For those with PV invasion or PV invasion by little tumor, but without invasion of vascular tunica intima, the pancreatic carcinoma could be removed. The contraindications of the operation for pancreatic and peri-ampullar carcinoma were as follows: surrounding of vessels by tumor, obvious narrow or embolization of the vessels, invasion of the superior mesenteric arteries and celiac trunk, invasion of vascular tunica intima of PV or tumor in vascular cavity.