腰背痛对胰腺癌胰外神经侵犯的预测价值  

Predictive value of lumbar back pain for extrapancreatic neural plexus invasion in pancreatic cancer

作　　者：汪雷[1] 张宏宇[2] 侯辉[1] 王槐志[2] 陶然[1] 吴春利[1] 

机构地区：[1]安徽医科大学第二附属医院普通外科,安徽合肥230601 [2]第三军医大学西南医院全军肝胆外科研究所,重庆400038

出　　处：《中国普通外科杂志》2016年第3期387-393,共7页China Journal of General Surgery

摘　　要：目的：探讨腰背痛症状对胰腺癌胰外神经侵犯的预测价值。方法：回顾性分析130例胰腺癌患者的临床及影像学资料。所有患者通过CT判断有无胰外神经侵犯,分析腰背痛症状预测胰腺癌胰外神经侵犯与CT判断结果的差异。结果：CT判断77例（59.2%）患者有胰外神经侵犯,其中胰头癌38例（50.7%,38/75）,胰体尾癌39例（70.9%,39/55）,后者比例明显高于前者（χ^278.999,P=0.000）;87.0%的可见腹腔干周围神经丛受侵表现,高于左侧腹腔神经节（57.1%）和右侧腹腔神经节受侵率（45.5%）（χ^230.415,P=0.000）。48例腰背痛患者中,有47例（97.9%）CT判断有胰外神经侵犯。与CT判断结果比较,本组中腰背痛预测胰腺癌胰外神经侵犯的灵敏度为61.0%,特异性为98.1%,阳性预测值97.9%。一致性检验结果显示,两者有中等一致性（κ=0.545,P=0.000）。结论：腰背痛症状与胰腺癌胰外神经侵犯有关,腰背痛症状和CT影像学特征性改变对于术前预测胰腺癌胰外神经侵犯有互补作用。Objective： To determine the predictive value of the symptoms of lumbar back pain for extrapancreatic neural plexus invasion in pancreatic cancer. Methods： The clinical and imaging data of 130 patients diagnosed as pancreatic cancer were retrospectively analyzed. Whether or not there was extrapancreatic neural plexus invasion was judged by CT in all patients, and the difference of the prediction of symptoms of lumbar back pain for extrapancreatic neural plexus invasion in pancreatic cancer and CT determination were analyzed.Results： Seventy-seven patients（59.2%） were judged to have extrapancreatic neural invasion by CT scan, wherein 38 cases（50.7%, 38/75） had cancer of the pancreatic head, 39 cases（70.9%, 39/55） had cancer of thepancreatic body and tail, and the percentage of the latter was significantly higher than that of the former（χ^278.999, P=0.000）; 87.0% of patients had tumor invasion around the celiac axis, which was significantly higher than those with tumor invasion in left celiac ganglion（57.1%） and right celiac ganglion（45.5%）（χ^230.415, P=0.000）. Of the 48 patients in lumbar back pain group, 47cases（97.9%） were diagnosed with extrapancreatic neural plexus invasion by CT scan. Compared with CT diagnosis, the sensitivity, specificity and positive predictive value of lumbar back pain for predicting extrapancreatic neural plexus invasion was 61%, 98.1% and 97.9%, respectively. Results of consistency check showed that there was a moderate consistency between the two methods（κ=0.545, P=0.000）. Conclusion： There is a relationship between symptoms of lumbar back pain and extrapancreatic neural plexus invasion in pancreatic cancer, and lumbar back pain and CT image features have complementary roles in preoperative prediction of extrapancreatic neural plexus invasion in pancreatic cancer.

关 键 词：胰腺肿瘤 肿瘤侵润 背痛 

分 类 号：R735.9[医药卫生—肿瘤]