杨红;钱家鸣;杨爱明;郭涛;麦灿荣;陆星华;王健;王鑫;
YANG Hong,QIAN Jia-ming,YANG Ai-ming,GUO Tao,MAI Can-rong,LU Xing-hua,WANG Jian,WANG Xin Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academyof Medical Sciences & Peking Union Medical College,Beijing 100730,China

• 1:中国医学科学院北京协和医学院北京协和医院消化科

摘要(Abstract)：

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。
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.

关键词(KeyWords)： 胰腺癌;诊断,影像学
pancreatic carcinoma; diagnosis,imaging techniques

Abstract:

Keywords:

基金项目(Foundation): 杨森科学研究基金项目;; 高等学校博士点专项科研基金(20060023016)

作者(Author): 杨红;钱家鸣;杨爱明;郭涛;麦灿荣;陆星华;王健;王鑫;
YANG Hong,QIAN Jia-ming,YANG Ai-ming,GUO Tao,MAI Can-rong,LU Xing-hua,WANG Jian,WANG Xin Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academyof Medical Sciences & Peking Union Medical College,Beijing 100730,China

Email:

DOI:

参考文献(References)：

• [1]Wagner M,Redaelli C,Lietz M,et al.Curative resection isthe single mostimportantfactordeterminingoutcome in patients with pancreatic adenocarcinoma[J].Br J Surg,2004,91:586-594.
• [2]Donofrio M,Gallotti A,Mucell RP.Imaging techniques in pancreatic tumors[J].Expert Rev Med Devices,2010,7:257-273.
• [3]Canto MI,Goggins M,Hruban RH,etal.Screening forearly pancreatic neoplasia in high-risk individuals:a prospective controlled study[J].Clin Gastroenterol Hepatol,2006,4:766-781.
• [4]Halefoglu AM.Magnetic resonance cholangiopancreatogra-phy:a useful tool in the evaluation of pancreatic and biliary disorders[J].World J Gastroenterol,2007,13:2529-2534.
• [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.
• [6]Buchs NC,Chilcott M,Poletti PA,et al.Vascular invasion in pancreatic cancer:imaging modalities,preoperative diag-nosis and surgical management[J].World J Gastroenterol,2010,21,16:818-831.
• [7]Sugiyama M,Hagi H,Atomi Y,et al.Diagnosis of portal ve-nous invasion by pancreatobiliary carcinoma:value of endo-scopic ultrasonography[J].Abdom Imaging,1997,22:434-438.
• [8]Aslanian H,Salem R,Lee J,et al.EUS diagnosis of vascu-lar invasion in pancreatic cancer:surgical and histologic cor-relates[J].Am J Gastroenterol,2005,100:1381-1385.
• [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.