發(fā)布時(shí)間：2018-01-08 17:10

  本文關(guān)鍵詞：腹腔神經(jīng)節(jié)的MSCT表現(xiàn)及胰腺癌胰外神經(jīng)侵犯MSCT診斷的初步探討　出處：《山西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腹腔神經(jīng)節(jié) MSCT 胰腺癌 胰外神經(jīng)侵犯

【摘要】：目的：(1)分析腹腔神經(jīng)節(jié)的MSCT表現(xiàn),以期為臨床更準(zhǔn)確有效的進(jìn)行CT引導(dǎo)下腹腔神經(jīng)叢阻滯術(shù)及胰周神經(jīng)結(jié)構(gòu)影像解剖提供必要參考信息。(2)初步探討MSCT對胰腺癌胰外神經(jīng)侵犯的診斷價(jià)值。方法：(1)觀察150例正常成人的腹部MSCT圖像,記錄和測量雙側(cè)腹腔神經(jīng)節(jié)的顯示率、位置、形態(tài)、大小及各期CT值,并進(jìn)行相關(guān)統(tǒng)計(jì)學(xué)分析。(2)回顧性分析16例行手術(shù)切除和病理證實(shí)的胰腺癌患者的MSCT資料,將胰外神經(jīng)走行區(qū)即病灶與腹腔神經(jīng)節(jié)和(或)周圍血管之間脂肪間隙內(nèi)出現(xiàn)粗網(wǎng)線影或軟組織密度影確定為胰外神經(jīng)侵犯的MSCT征象,以病理結(jié)果為金標(biāo)準(zhǔn),對照分析MSCT對胰腺癌胰外神經(jīng)侵犯診斷的敏感性、特異性和準(zhǔn)確性。結(jié)果：(1)、150例正常成人中左側(cè)腹腔神經(jīng)節(jié)141例顯示(94%),9例不顯示,右側(cè)腹腔神經(jīng)節(jié)中124例顯示(82.7%),26例不顯示,左側(cè)顯示率高于右側(cè)(P=0.0040.05)。雙側(cè)腹腔神經(jīng)節(jié)均位于腹腔干至腸系膜上動(dòng)脈層面,平T12-L1水平；右側(cè)腹腔神經(jīng)節(jié)位于下腔靜脈后內(nèi)側(cè)與右側(cè)膈肌腳之間,左側(cè)腹腔神經(jīng)節(jié)位于左側(cè)腎上腺前內(nèi)側(cè)與左側(cè)膈肌腳之間。MSCT軸位圖像中腹腔神經(jīng)節(jié)形態(tài)分為長條形和多結(jié)節(jié)形兩種,左側(cè)長條形92例(65.2%),多結(jié)節(jié)形49例(34.8%),右側(cè)長條形102例(82.3%),多結(jié)節(jié)形22例(17.7%),左側(cè)多結(jié)節(jié)形多于右側(cè)(P0.05)。左、右側(cè)腹腔神經(jīng)節(jié)長徑分別為(22.8±4.1)mm、 (27.6±4.2)mm,右側(cè)長徑長于左側(cè)長徑(P0.001),左、右側(cè)短徑分別為(3.5±0.8)mm,(2.4±0.6)mm,左側(cè)短徑長于右側(cè)短徑(P0.001)。左側(cè)腹腔神經(jīng)節(jié)平掃期、動(dòng)脈期、靜脈期CT值為(24.8±4)HU.(53.9±7)HU.(72.4 ±10.1)HU。按性別分組：男性左、右側(cè)腹腔神經(jīng)節(jié)顯示率高于女性(P0.05)。按年齡分組：(20-40歲,32人)組、(40-60歲,79人)組及(60-80歲,39人)組之間左、右兩側(cè)腹腔神經(jīng)節(jié)顯示率存在差異性(P0.05)；各組間對比：(20-40歲)組左、右側(cè)腹腔神經(jīng)節(jié)顯示率低于(40-60歲)組(P0.0125)；(20-40歲)組與(60-80歲)組間左側(cè)腹腔神經(jīng)節(jié)顯示率差異無統(tǒng)計(jì)學(xué)意義(P0.0125),右側(cè)腹腔神經(jīng)節(jié)顯示率顯示率略低于(60-80歲)組(P=0.0100.0125)；(40-60歲)組與(60-80歲)組間左、右側(cè)腹腔神經(jīng)節(jié)顯示率差異均無統(tǒng)計(jì)學(xué)意義(P0.0125)。(2)、本研究中MSCT對胰腺癌胰外神經(jīng)侵犯診斷的敏感性、特異性和準(zhǔn)確性分別為85.7%(6/7)、55.6%(5/9)、68.8%(11/16),經(jīng)病理證實(shí)有胰外神經(jīng)侵犯6例中有2例病灶與腹腔神經(jīng)節(jié)間隙內(nèi)出現(xiàn)粗網(wǎng)線影,并與腹腔神經(jīng)節(jié)邊界不清,3例病灶與周圍血管間隙內(nèi)出現(xiàn)軟組織密度影,1例病灶與周圍血管間隙內(nèi)出現(xiàn)粗網(wǎng)線影。結(jié)論：(1)MSCT多數(shù)情況下能夠顯示雙側(cè)腹腔神經(jīng)節(jié)的位置、形態(tài)、大小等特征,左側(cè)腹腔神經(jīng)節(jié)顯示率高于右側(cè),主要是因?yàn)橛覀?cè)腹腔神經(jīng)節(jié)周圍結(jié)構(gòu)間隙較窄,部分體型較瘦者顯示不清。雙側(cè)腹腔神經(jīng)節(jié)的顯示率受性別和年齡因素的影響,我們認(rèn)為造成這種差異的主要原因是不同性別、年齡段的體型及內(nèi)臟器官飽滿度不同所導(dǎo)致。(2)胰腺癌患者M(jìn)SCT圖像中癌灶與腹腔神經(jīng)節(jié)和(或)周圍血管之間脂肪間隙出現(xiàn)粗網(wǎng)線影或軟組織密度影,高度提示胰腺癌發(fā)生胰外神經(jīng)侵犯。
[Abstract]:Objective: (1) to analyze the MSCT features of abdominal ganglion, in order to provide more accurate clinical effective CT guided neurolytic celiac plexus block and peripancreatic nerve anatomy structure to provide the necessary reference information. (2) to investigate the value of MSCT diagnosis of pancreatic cancer pancreatic neural invasion. Methods: (1) the abdomen MSCT images were observed in 150 cases of normal adults, record and measure the bilateral abdominal ganglion display rate, location, shape, size and the CT value, and the related statistical analysis. (2) a retrospective analysis of MSCT data of patients with pancreatic cancer 16 cases of surgical resection and confirmed by pathology, the extrapancreatic nerve area the lesion and the celiac ganglia and (or) peripheral blood vessels appeared in the gap between fat coarse wire shadow or soft tissue density to determine the MSCT signs of extrapancreatic nerve invasion, with pathological results as the gold standard, a comparative analysis of MSCT for pancreatic cancer diagnosis of pancreatic nerve invasion The sensitivity, specificity and accuracy. Results: (1), 150 cases showed 141 cases of left normal adult celiac ganglion (94%), 9 cases showed that 124 cases showed right celiac ganglion (82.7%), 26 cases showed that the left display rate is higher than the right side (P=0.0040.05). The bilateral abdominal ganglion were located in the celiac superior mesenteric artery to the level, the level of T12-L1; the right celiac ganglion is located between the inferior vena cava and right posterior medial crura of diaphragm, left celiac ganglion is located between the left adrenal gland and left anterior medial crura of diaphragm ganglion form abdominal axial.MSCT image is divided into rectangular shape and multiple nodules in two, left the strip 92 cases (65.2%), 49 cases of multiple nodules (34.8%), 102 cases on the right side of the strip (82.3%), 22 cases of multiple nodules (17.7%), left more nodules than in the right (P0.05). The left and right abdominal ganglion size respectively (22.8 + 4.1) mm, (27.6 + 4.2) mm ,鍙充晶闀垮緞闀夸簬宸︿晶闀垮緞(P0.001),宸，

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