手术前计算机断层扫描对胰十二指肠切除术后患者发生胰瘘的预测价值  

Value of preoperative computed tomography for prediction of pancreatic fistula after pancreaticoduodenectomy

作　　者：陈和平[1] 邵伟新[1] 龙德云[1] 

机构地区：[1]武警浙江省总队嘉兴医院放射科,浙江省嘉兴市314000

出　　处：《世界华人消化杂志》2015年第9期1489-1494,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨术前计算机断层扫描(computed tomography,CT)对患者胰十二指肠切除(pancreaticoduodenectomy,PD)术后发生胰瘘的预测效果.方法:回顾性分析2011-01/2014-06武警浙江省总队嘉兴医院收治的60例行标准PD手术的患者的临床和影像学资料,将患者分为发生胰瘘组和未发生胰瘘组,对术后发生胰瘘的患者根据胰瘘的严重程度分为A级、B级、C级.比较各组的胰体部C T值、胰体部/腹主动脉的CT比值、胰管直径、胰腺厚度,采用简单线性相关分析各CT检查结果与胰瘘的严重程度分级的相关性,并采用受试者工作特征(receiver operation characteristic,ROC)曲线下面积评价其对PD术后发生胰瘘的预测价值.结果:60例患者术后共发生胰瘘12例,发生率为20.0%,其中A级7例,B级3例,C级2例.发生胰瘘组的胰体部CT值、胰体部/腹主动脉CT值、胰管直径显著低于未发生胰瘘组,胰腺厚度显著高于未发生胰瘘组,差异均具有统计学意义(P<0.05).三个等级的胰瘘患者的各CT检查结果比较,差异均有统计学意义(F=9.658,8.730,8.931,10.050,P<0.05).胰瘘严重程度与胰体部CT值、胰体部/腹主动脉的CT比值、胰管直径呈负相关,与胰腺厚度呈正相关(P<0.05).胰体部CT值、胰体部/腹主动脉的CT比值、胰管直径、胰腺厚度的曲线下面积分别为0.820、0.794、0.809、0.765.结论:术前CT扫描对PD术后胰瘘的发生具有一定的预测价值,建议综合各指标进行调整术中的吻合方法和围手术期的管理措施,达到减少术后胰瘘发生风险、改善患者预后的目的.AIM：To assess the value of preoperative computed tomography（CT） for prediction of pancreatic fistula after pancreaticoduodenectomy（PD）.METHODS：The clinical and imaging data for60 patients who received PD from January2011 to June 2014 at our hospital were retrospectively analyzed.Cases were divided into two groups,those with pancreatic fistula group and those without.Patients with pancreatic fistula were divided into three subgroups based on the grade of pancreatic fistula：A,B and C.The pancreatic CT HU,the CT HU ratio of the pancreas/abdominal aorta,pancreatic duct diameter and pancreatic gland thickness were compared among all groups.Simple linear correlation analysis was performed to analyze the correlation between the results of CT and severity of pancreatic fistula.The area under the receiver operation characteristic（ROC） curve was used to evaluate the value of these results of CT for prediction of pancreatic fistula after PD.RESULTS：Twelve（20.0%） cases of pancreatic fistula occurred after PD,including 7 cases of grade A,3 cases of grade B and 2 cases of grade C.The pancreatic CT HU,the CT HU ratio of the pancreas/abdominal aorta,and pancreatic duct diameter were significantly lower in patients with pancreatic fistula than those without,and pancreatic gland thickness was significantly lower in the pancreatic fistula group（P〈0.05）.There were significant differences in all results of CT between three grades of pancreatic fistula.The severity of pancreatic fistula was negatively related to the pancreatic CT HU,the CT HU ratio of the pancreas/abdominal aorta,and pancreatic duct diameter,but positively to pancreatic gland thickness.The area under the ROC curve of the pancreatic CT HU,the CT HU ratio of the pancreas/abdominal aorta,pancreatic duct diameter and pancreatic gland thickness was0.820,0.794,0.809 and 0.765,respectively.CONCLUSION：Preoperative CT imaging has certain value for prediction of pancreatic fistula after PD.The method of anastomosis and perioperative management sh

关 键 词：CT扫描 胰瘘 胰十二指肠切除术 

分 类 号：R656[医药卫生—外科学] R816.5[医药卫生—临床医学]