【摘要】：研究目的：隨著醫(yī)學(xué)技術(shù)的發(fā)展,醫(yī)療檢查設(shè)備的更新,胰腺癌的檢出率不斷提高,但這種疾病在得到診斷時(shí)往往處于晚期,病程進(jìn)展快,預(yù)后差,而根治性胰腺癌切除術(shù)是目前最有效的方法,但這種手術(shù)創(chuàng)傷大,術(shù)后患者恢復(fù)慢,術(shù)前如果沒有準(zhǔn)確充分的可切除性評(píng)估,對(duì)于不可切除的患者來說既增加了創(chuàng)傷又沒有很好的治療效果,故而術(shù)前有效的影像學(xué)評(píng)估非常重要。近年來,隨著內(nèi)鏡技術(shù)的發(fā)展,超聲內(nèi)鏡逐漸運(yùn)用于胰腺癌的診療過程中,本研究將超聲內(nèi)鏡檢查與目前常用的B超、CT、MRI三種檢查方式對(duì)比,判斷其各自在胰腺癌可切除性方面的價(jià)值所在,尋求術(shù)前判斷其可切除性的最佳方法。研究方法：本研究搜集整理了蘭州大學(xué)第一醫(yī)院普外二科2013年4月-2014年12月間,經(jīng)B超、腹部增強(qiáng)CT及MRI檢查,擬診斷為胰腺癌的41例患者,準(zhǔn)備行胰腺癌根治性切除術(shù),術(shù)前進(jìn)一步行超聲內(nèi)鏡檢查判斷其可切除性的患者病例資料,分析各項(xiàng)輔助檢查中病灶的大小及部位、血管侵犯情況、淋巴結(jié)轉(zhuǎn)移情況、有無遠(yuǎn)處轉(zhuǎn)移等方面,進(jìn)一步評(píng)判其可切除性,并以此來比較EUS相對(duì)于B超、腹部增強(qiáng)CT、MRI檢查在胰腺癌可切除性方面的評(píng)估價(jià)值。研究結(jié)果：41例入組的患者均開腹手術(shù)治療,成功根治性切除26例,未切除15例,病理證實(shí)入組患者均確診為胰腺癌。EUS檢查與增強(qiáng)CT、MRI在胰腺癌可切除性判斷結(jié)果比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),腹部增強(qiáng)CT、MRI、EUS、CT結(jié)合EUS、MRI結(jié)合EUS等判定方法與術(shù)中實(shí)際情況檢驗(yàn)κ值分別為0.89、0.79、0.84、0.95、0.89,腹部增強(qiáng)CT結(jié)合EUS在胰腺癌術(shù)前可切除性評(píng)判與術(shù)中實(shí)際情況一致性最高。結(jié)論：經(jīng)腹部B超因其診斷價(jià)值較低,故而不適用于胰腺癌可切除性判斷。腹部增強(qiáng)CT、MRI、EUS檢查對(duì)于胰腺癌的可切除性均有著較為重要的臨床價(jià)值,EUS是內(nèi)鏡與超聲的結(jié)合體,其可直接觀察消化道黏膜,亦可靈活進(jìn)行實(shí)時(shí)超聲掃查,獲取消化道管壁層次及胰周重要血管、淋巴結(jié)等部位是否受侵犯的準(zhǔn)確圖像。增強(qiáng)CT結(jié)合EUS是術(shù)前判斷胰腺癌是否可切除的最佳選擇。
[Abstract]:Objective: with the development of medical technology and the renewal of medical examination equipment, the detection rate of pancreatic cancer is increasing. However, the diagnosis of this disease is often in the late stage, the course of disease progress quickly, and the prognosis is poor. Radical resection of pancreatic cancer is the most effective method at present, but the surgical trauma is great and the patient recovers slowly. If there is no accurate and sufficient resectability assessment before operation, For unresectable patients, the trauma is increased and the therapeutic effect is not good, so effective imaging evaluation before operation is very important. In recent years, with the development of endoscopic technology, ultrasound endoscopy is gradually used in the diagnosis and treatment of pancreatic cancer. To determine their respective value in resectability of pancreatic cancer and to find the best method to determine the resectability of pancreatic cancer before operation. Methods: from April 2013 to December 2014, 41 patients with pancreatic cancer were examined by B-ultrasound, abdominal enhanced CT and MRI, and were prepared to undergo radical resection of pancreatic cancer. Further endoscopic ultrasonography was performed before operation to determine the resectability of the patients. The size and location of the lesions, vascular invasion, lymph node metastasis, and whether there were distant metastasis were analyzed. To evaluate the resectability of pancreatic cancer and compare the value of EUS with B-ultrasound, abdominal enhanced CT,MRI in evaluating the resectability of pancreatic cancer. Results: all 41 patients were treated by open surgery, 26 cases were resected successfully, 15 cases were not resected. All the patients were confirmed to be pancreatic cancer by pathology. The results of EUS and enhanced CT,MRI were compared with those of enhanced CT,MRI in judging the resectability of pancreatic cancer. The difference was statistically significant (P0.05). The 魏 values of abdominal enhanced CT,MRI,EUS,CT combined with EUS,MRI combined with EUS were 0.89 and 0.89, respectively. Abdominal contrast enhanced CT combined with EUS was the most consistent between preoperative resectability and intraoperative practice of pancreatic cancer. Conclusion: because of its low diagnostic value, transabdominal B-mode ultrasound is not suitable for judging the resectability of pancreatic cancer. Abdominal enhanced CT,MRI,EUS has important clinical value for the resectability of pancreatic cancer. EUS is a combination of endoscopy and ultrasound. It can directly observe the mucosa of digestive tract, and it can also perform real-time ultrasound scan. Obtain accurate images of the digestive tract wall, peripancreatic important vessels, lymph nodes and other parts of the invasion. Contrast-enhanced CT combined with EUS is the best choice to evaluate the resectability of pancreatic cancer before operation.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.9

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