摘要
目的探讨建立胰腺钩突部肿瘤累及肠系膜上静脉(SMV)的程度及临床分级,以指导临床医生术前评估和手术方案的制定。方法根据薄层增强CT及计算机辅助X线断层摄影术(CTA)的检查结果,对143例胰腺钩突部肿瘤累及SMV的患者进行临床分级,即T分级,分别为T1级(界限清楚型)、T2级(界限模糊型)、T3级(界限消失型)和T4级(界限“渗透”型,又称血管侵犯型)。分析术前T分级和手术中实际分级(S分级)的一致性。结果T分级中4种不同的临床分级与所选择的手术方式有明显差别,T1级和T2级胰腺钩突部肿瘤累及SMV的手术切除率分别为100%和97.4%,T3级和T4级分别为65.8%和21.7%。术前T分级与S分级具有一致性(U=15.96,P<0.01)。结论对胰腺钩突部肿瘤累及SMV的程度进行临床分级,有助于指导临床医生准确判断胰腺钩突部肿瘤的解剖特点及制定更为合理的手术方案。
Objective To create the clinical degree of the superior mesenteric vein （SMV） involvement in pancreas uncinate process carcinoma （PUPC） and its clinical significance to be discussed. Methods According to the contiguous relationship between the SMV and the PUPC, the clinical degree of SMV involvement in PUPC are as followings four grades, 1 grade, the grade of clear boundary. 2 grade, the grade of fuzzy boundary. 3 grade, the grade of dissolved boundary. 4 grade, the grade of SMV infringed. The coherence between the type under the CT scan（Tx） and the type under the inoperative judgement（Sx） were analyzed with Kappa-test. Results There is a significant difference between the grade of SMV involvement and the surgery. The resection rate is 100% in 1st grade, 97.4% in 2nd grade, 65.8% in 3rd grade and 21.7% in 4th grade. There is coherent in the degree judgement between the CT scan and the inoperative inspection （ U = 15.96,P 〈 0. 01 ） . Conclusions There is clinical significance to establish the degree of SMV involvement in PUPC. It is helpful for clinician to accurately know its anatomic characteristic and decide more reasonable surgical strategy.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2006年第5期317-320,共4页
Chinese Journal of Surgery
