【作者】 田艳涛；

【导师】 赵平；

【作者基本信息】 中国协和医科大学 ， 肿瘤学， 2005， 博士

【摘要】 彩色多普勒血流显像、内镜超声检查、螺旋CT、核磁共振与胰腺癌可切除性相关性的前瞻性研究 近年，胰腺癌(pancreatic cancer，PC)发病率呈上升趋势，其预后极差，1年生存率不到30％，5年生存率仅3％～7％。在我国胰腺癌发病率持续上升。目前外科手术根治性切除仍是延长其生存期的最佳选择，遗憾的是大多数胰腺癌患者在临床确诊时已属晚期，仅有10％～25％的患者能成功切除。术前准确地评估其可切除性至关重要，既可以使无法手术切除的患者免遭手术之苦，又不会使可切除患者失去手术的唯一机会。如没有发生转移，胰腺癌手术切除的可能性主要依赖于肿瘤和相邻血管组织即肠系膜上动静脉、门静脉、腹腔动脉干等的关系。我们运用彩色多普勒血流显像技术(Color Doppler Flow Imaging，CDFI)、内镜超声检查(Endoscopic Ultrasonography，EUS)、螺旋CT(Helical Computed Tomography，HCT)、核磁共振检查(Magnetic Resonance Imaging，MRI)对68例胰腺癌的肿瘤部位、肿瘤大小、毗邻脏器受侵、远处转移、淋巴结转移、血管受侵范围和程度、胰胆管扩张的程度、TNM分期以及可切除性进行了前瞻性评估和预测，并与手术和病理结果进行比较。并对同期手术治疗的26例壶腹癌四种影像学技术的肿瘤直接征象显示情况、壶腹癌与胰腺癌生物学特性的差异、TNM分期构成差异进行了比较研究。 所有连续收治适合手术治疗的胰腺癌患者于术前完成彩色多普勒血流显像技术、内镜超声检查、螺旋CT、核磁共振检查，每种影像学技术的评估均包括原发肿瘤部位、局部浸润情况、淋巴结转移、血管侵犯程度、远处转移和TNM分期和肿瘤的可切除性作出判断并与外科发现进行比较，统计学处理应用直线回归、单元和多元logistic回归分析、Kappa检验、wilcoxon检验和x~2检验、敏感性、特异性、准确性和阳性预测价值、阴性预更多还原

【Abstract】 Pancreatic cancer is associated with an extremely poor prognosis, no more than 30% of patients can survive 1 year, and only 3%~7% of them can survive 5 years after the diagnosis. In China, the incidence of Pancreatic cancer keeps the trend of rising. Surgical resection remains the only chance for cure in these patients. However, surgical exploration without adequate preoperative attempts to determine resectability results in resection in only 10% to 25% of patients. Accurate preoperative Assessment of resectability of pancreatic carcinoma is essential to avoid unnecessary surgeries and, at the same, to not deny the opportunities for cure to patients with resectable diseases. In the absence of metastatic diseases, which clearly precludes resection, assessment of vascular invasion is the most important parameter for determining resectability in pancreatic cancer such as the anatomical relation between the tumor and superior mesenteric vein, superior mesenteric artery, portal vein and so on.The objective of this study was to evaluate prospectively the efficacy of different strategies based on Color Doppler Flow Imaging (CDFI), Endoscopic Ultrasonography (EUS), Helical Computed Tomography(HCT), and Magnetic Resonance Imaging(MRI) in the staging and tumor resectability assessment of Pancreatic Cancer.All consecutive patients with pancreatic carcinoma judged fit for更多还原