CT评估胰头癌系膜侵犯的价值

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摘要目的探讨CT评估胰头癌(PHC)系膜侵犯的价值。方法回顾性分析2016-02至2022-01 58例在火箭军特色医学中心行胰腺全系膜切除术(TMpE)并经病理证实为R0切除的PHC患者的临床和CT影像资料。通过术后1年内随访情况将全部病例分为复发组(30例)及未复发组(28例)。分别选取肠系膜上静脉-门静脉后缘、腹腔干开口处右侧缘、腹腔干开口处上方2 cm处右侧缘、肠系膜上动脉开口处右侧缘、左肾静脉下腔静脉汇入口-腹主动脉连线前缘共5个成像层面测量两组胰腺系膜区域平扫、动脉期和静脉期的CT值并计算动脉期及静脉期的CT值变化率。对复发组5个层面上胰腺系膜的三期CT值及动、静脉期CT值变化率进行ROC分析,比较其评价系膜侵犯的诊断效能,并比较各诊断指标间的效能差异。结果复发组与未复发组在5个成像层面的平扫CT值、动脉期CT值、静脉期CT值差异均有统计学意义(P<0.05)。两组胰腺系膜的动脉期及静脉期CT值变化率在腹腔干开口处上方2 cm处右侧缘成像层面上无差异,其余4个成像层面上均有差异:动脉期CT值变化率(187.0% vs. 24.0%,85.7% vs. 25.2%,198.7% vs. 29.3%,668.1% vs. 33.0%;P<0.05);静脉期CT值变化率(297.0% vs. 35.0%,140.4% vs. 31.5%,402.1% vs. 33.4%,142.9% vs. 47.4%;P<0.05)。同一观测层面内的各诊断指标在评价系膜侵犯的效能上没有差异,肠系膜上静脉-门静脉后缘层面对评价系膜侵犯的AUC值最大(0.886,95% CI:0.786~0.951),特异度为95.8%,灵敏度为83.3%。结论 CT对评估PHC系膜侵犯具有一定的临床应用价值,可为胰腺全系膜切除手术范围及术后治疗方案提供新的依据。

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关键词 ：胰头癌, 胰腺系膜, 胰腺全系膜切除, CT

Abstract：Objective To evaluate the value of CT in the evaluation of mesopancreas invasion of pancreatic head carcinoma (PHC). Methods The clinical and CT imaging data of 58 PHC patients who underwent total mesopancreas excision (TMpE) and were pathologically confirmed to have R0 resection from February 2016 to January 2022 in Characteristics Medical Center of PLA Rocket Force were retrospectively analyzed. All the patients were divided into recurrence group (30 cases) and non-recurrence group (28 cases) by 1 year follow-up. A total of five imaging levels, including the posterior border of the superior mesenteric vein-portal vein, the right edge of the opening of the celiac trunk, the right edge 2 cm above the opening of the celiac trunk, the right edge of the opening of the superior mesenteric artery, and the anterior edge of the left renal vein inferior vena cava confluence-abdominal aorta connection were selected to measure the CT values of mesopancreas region in the plain scanning, arterial-phase and venous-phase of the two groups, and the rate of change of the CT values of the arterial-phase and venous-phase was calculated. ROC analysis was performed on the three-phase CT values and the rate of change of CT values in the arterial-phase and venous-phase of the mesopancreas at five levels in the recurrence group to evaluate the diagnostic efficacy of the mesopancreas invasion and to compare the differences in efficacy between diagnostic indicators. Results The plain scan CT values, arterial-phase CT values and venous-phase CT values in 5 imaging levels were significantly different between the recurrence group and the non-recurrence group (P<0.05).The rate of change of arterial-phase and venous-phase CT values in the mesopancreas of the two groups showed no difference at the imaging level of the right margin 2 cm above the opening of the celiac trunk, and there were differences at the remaining four imaging levels. The rate of change of arterial-phase CT values were 187.0% vs.24.0%, 85.7% vs. 25.2%, 198.7% vs. 29.3%, 668.1% vs. 33.0% (P<0.05). The rate of change of venous-phase CT values were 297.0% vs. 35.0 %, 140.4% vs. 31.5%, 402.1% vs. 33.4%, 142.9% vs. 47.4% (P<0.05). There was no difference in the efficacy of each diagnostic index in the evaluation of mesopancreas invasion in the same observation level. The indexes in the superior mesenteric vein-portal posterior margin level had the largest AUC value(0.886, 95%CI: 0.786-0.951) with a specificity of 95.8% and sensitivity of 83.3%. Conclusions CT has a certain clinical value in the evaluation of mesopancreas invasion of PHC, and can provide a new basis for the scope of total mesopancreas excision of pancreas and postoperative treatment.

Key words： pancreatic head carcinoma mesopancreas total mesopancreas excision CT

收稿日期: 2024-06-24

ZTFLH:

R445.3

通讯作者: 徐磊,E-mail:leixu2001@hotmail.com

作者简介: 冯培,硕士研究生,主治医师。

引用本文:

冯培, 潘晶晶, 刘桐, 范薇, 徐磊. CT评估胰头癌系膜侵犯的价值[J]. 武警医学, 2024, 35(11): 930-934. FENG Pei, PAN Jingjing, LIU Tong, FAN Wei, Xu Lei. Value of CT to evaluate mesangial invasion in pancreatic head cancer. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(11): 930-934.

链接本文:

https://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 https://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2024/V35/I11/930

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