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摘要:目的 分析胰腺癌患者影像学检查的意义及过去14年胰腺癌患者影像学检查的发展趋势, 以提高对胰腺癌影像学检查的认识。方法 回顾性分析北京协和医院1995年10月至2009年10月414例胰腺癌患者的各种影像学检查资料。结果 (1) 内镜下逆行胰胆管造影(encoscopic retrograde cholangio-pancreatography, ERCP)和超声内镜(en-doscopic ultrasonography, EUS)是诊断胰腺癌最敏感的影像学手段; (2)1995至2003年与2004至2009年比较, 以B超为首诊检查的患者人数显著下降(90.3% vs.74.5%, P=0.000), 而以CT做为首诊检查的患者人数在增加(9.0% vs.24.6%, P=0.000);(3)ERCP对胆管及胰管病变检出率与磁共振胆胰管成像(magnetic resonance cholangio-pancre-atography, MRCP)符合率分别为86.7%和75.0%, MRCP与B超、CT、EUS比较是检测胰胆管病变最敏感的检测手段(P < 0.05);(4)CT血管重建对脾动静脉、门静脉和肠系膜血管浸润的检出率达80%、80%和60%。结论 了解各种影像学手段对胰腺癌诊断的特点, 对胰腺癌临床早期诊断及治疗具有指导意义。Abstract:Objective To analyze the role of different imaging techniques in the diagnosis of pancreatic carcinoma and learn the changing in the past fourteen years, in order to improve the knowledge of pancreatic carcinoma.Methods The clinical data and imaging results of 414 patients with pancreatic carcinoma who received imaging examinations in our hospital from August 1995 to August 2009 were retrospectively analyzed.Results The most sensitive imaging techniques were encoscopic retrograde cholangio-pancreatography (ERCP) and endoscopic ultrasonography (EUS). Comparison of the periods between 1995-2003 and 2004-2009 showed that rate of using ultrasound as the initial choice has decreased significantly from 90.3% to 74.5%, while the rate of computed tomography was increasing(9.0% vs. 24.6%) (both P=0.000). The coincidence rate between magnetic resonance cholangio-pancreatography (MRCP) and ERCP in the diagnosis ofpancreatic duct and bile duct was 86.7% and 75.0%, respectively; furthermore, compared with ultrasound, CT, and EUS, MRCP was the most sensitive technique in detecting lesions in these locations. Angio-CT showed a performance of 80% in the detection of vascular invasion in splenic vessels and in portal vein, and 60% in the superior mesenteric vessels.Conclusion Different imaging techniques have varied performances in the diagnosis of pancreatic carcinoma and should be applied reasonably.
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Keywords:
- pancreatic carcinoma /
- diagnosis, imaging techniques
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北京协和医院血管外科刘昌伟教授对2002年4月至2008年4月收治的10例贝赫切特病(白塞病)合并主动脉假性动脉瘤患者的预后情况进行研究, 认为腔内治疗是一种可行、有效的方法, 而术后坚持长期有效的免疫抑制治疗是减少复发、降低死亡率的关键。该研究结果已发表在JVasc Surg杂志上, SCI影响因子达3.77。
Behcet(贝赫切特)病, 是一种多系统的慢性损害性综合征。临床症状主要有:复发性口腔溃疡、生殖器溃疡及复发性葡萄膜炎等。贝赫切特病伴有主动脉受累的患者, 临床上并不多见, 文献报道约为1.5% ~ 2.7%, 但死亡率高、预后极差, 未经手术治疗的患者多死于主动脉假性动脉瘤破裂。1998年Vasseur等首次报道通过分叉型支架植入成功治疗1例贝赫切特病合并主—髂动脉假性动脉瘤的患者, 证实了对此类患者腔内治疗的可行性。
北京协和医院血管外科自2002年4月始, 尝试对贝赫切特病主动脉假性动脉瘤进行腔内治疗, 截至2008年4月共积累了10例病例, 腔内治疗均获成功, 并在国内首先开展利用主动脉支架自行开窗植入治疗累及肾动脉的主动脉假性动脉瘤2例, 获得成功。10例患者中2例在术后出现支架近端假性动脉瘤复发, 这2例复发的患者均未坚持进行激素治疗。
通过对国内外多篇文献的总结, 并结合实际临床经验, 刘昌伟教授认为, 腔内治疗对于贝赫切特病合并主动脉假性动脉瘤是一种可行、有效的方法。而术后坚持长期有效的免疫抑制治疗亦十分必要, 能有效地减少复发、降低死亡率。
(北京协和医院血管外科 叶炜 刘暴，宣传处 陈明雁)
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[1] Wagner M, Redaelli C, Lietz M, et al.Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma[J].Br J Surg, 2004, 91: 586-594. DOI: 10.1002/bjs.4484
[2] Donofrio M, Gallotti A, Mucell RP.Imaging techniques in pancreatic tumors[J].Expert Rev Med Devices, 2010, 7: 257-273. DOI: 10.1586/erd.09.67
[3] Canto MI, Goggins M, Hruban RH, et al.Screening for early pancreatic neoplasia in high-risk individuals:a prospective controlled study[J].Clin Gastroenterol Hepatol, 2006, 4: 766-781. DOI: 10.1016/j.cgh.2006.02.005
[4] Halefoglu AM. Magnetic resonance cholangiopancreatography:a useful tool in the evaluation of pancreatic and biliary disorders[J]. World J Gastroenterol, 2007, 13:2529- 2534. DOI: 10.3748/wjg.v13.i18.2529
[5] 卢延.胰腺癌CT与MR诊断新进展[J].中国医学计算机成像杂志, 1999, 5:240-244. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgyxjsjcx199904004 [6] Buchs NC, Chilcott M, Poletti PA, et al.Vascular invasion in pancreatic cancer:imaging modalities, preoperative diagnosis and surgical management[J].World J Gastroenterol, 2010, 21, 16:818-831. http://europepmc.org/abstract/PMC/PMC2825328
[7] Sugiyama M, Hagi H, Atomi Y, et al.Diagnosis of portal venous invasion by pancreatobiliary carcinoma:value of endoscopic ultrasonography[J].Abdom Imaging, 1997, 22:434-438. DOI: 10.1007/s002619900227
[8] Aslanian H, Salem R, Lee J, et al.EUS diagnosis of vascular invasion in pancreatic cancer:surgical and histologic correlates[J].Am J Gastroenterol, 2005, 100:1381-1385. DOI: 10.1111/j.1572-0241.2005.41675.x
[9] 杨红, 钱家鸣, 张惠广, 等.不同时期胰腺癌易感因素的比较和分析[J].中华消化杂志, 2003, 23:587-590. http://d.wanfangdata.com.cn/Periodical/yxbx2003z1143
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