Scialpi Michele, Scaglione Mariano, Volterrani Luca, Lupattelli Luciano, Ragozzino Alfonso, Romano Stefania, Rotondo Antonio
Department of Radiology, Santissima Annunziata Hospital, Via Bruno 1, I-74100 Taranto, Italy.
Eur J Radiol. 2005 Mar;53(3):417-24. doi: 10.1016/j.ejrad.2004.12.013.
The role of several imaging techniques in patients submitted to pancreatic surgery with special emphasis to single-slice helical computed tomography (CT) and multidetector-row CT (MDCT) was reviewed. Several surgical options may be performed such as Whipple procedure, distal pancreatectomy, central pancreatectomy, and total pancreatectomy. Ultrasound examination may be used to detect peritoneal fluid in the early post-operative period as well as lesion recurrence in long-term follow-up. Radiological gastrointestinal studies has a major role in evaluation of intestinal functionality. In spite of the advent of other imaging modalities, CT is the most effective after pancreatic surgery. On post-operative CT, the most common findings were small fluid peritoneal or pancreatic collections, stranding of the mesenteric fat with perivascular cuffing, reactive adenopathy and pneumobilia. In addition, CT may demonstrate early (leakage of anastomosis, pancreatico-jejunal fistula, haemorrage, acute pancreatitis of the remnant pancreas, peritonitis), and late (chronic fistula, abscess, aneurysms, anastomotic bilio-digestive stenosis, perianastomotic ulcers, biloma, and intra-abdominal bleeding) surgical complications. In the follow-up evaluation, CT may show tumor recurrence, liver and lymph nodes metastasis. Magnetic resonance may be used as alternative imaging modality to CT, when renal insufficiency or contrast sensitivity prevents the use of iodinated i.v. contrast material or when the biliary tree study is primarily requested. The knowledge of the type of surgical procedures, the proper identification of the anastomoses as well as the normal post-operative imaging appearances are essential for an accurate detection of the complications and recurrent disease.
回顾了几种成像技术在接受胰腺手术患者中的作用，特别强调了单层螺旋计算机断层扫描（CT）和多排探测器CT（MDCT）。可以进行多种手术选择，如惠普尔手术、胰体尾切除术、中段胰腺切除术和全胰切除术。超声检查可用于术后早期检测腹腔积液以及长期随访中病变的复发。放射学胃肠道研究在评估肠道功能方面起主要作用。尽管出现了其他成像方式，但CT在胰腺手术后是最有效的。术后CT最常见的表现为少量腹腔或胰腺积液、肠系膜脂肪条索伴血管周围套袖征、反应性淋巴结肿大和气胆。此外，CT可显示早期（吻合口漏、胰空肠瘘、出血、残余胰腺急性胰腺炎、腹膜炎）和晚期（慢性瘘、脓肿、动脉瘤、吻合口胆肠狭窄、吻合口周围溃疡、胆汁瘤和腹腔内出血）手术并发症。在随访评估中，CT可显示肿瘤复发、肝和淋巴结转移。当肾功能不全或对比剂敏感性妨碍使用静脉注射碘对比剂或主要需要进行胆道系统研究时，磁共振成像可作为CT的替代成像方式。了解手术方式类型、正确识别吻合口以及正常的术后影像学表现对于准确检测并发症和复发性疾病至关重要。
