Kern Alexander, Dobrowolski Frank, Kersting Stephan, Dittert Dag-Daniel, Saeger Hans Detlev, Kuhlisch Eberhard, Bunk Alfred
Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
Ann Surg Oncol. 2008 Apr;15(4):1137-46. doi: 10.1245/s10434-007-9735-7. Epub 2007 Dec 19.
Tumor infiltration of the intima of the portal vein (PV) and superior mesenteric vein (SMV) by pancreatic adenocarcinoma is classically considered a criterion for unsuitability for resection and poor prognosis. This study was performed to evaluate modern color duplex imaging (CDI) for the assessment of PV/SMV infiltration by pancreatic adenocarcinomas.
From 1994 to 2005, Whipple's procedure or pylorus-preserving pancreato-duodenectomy (PPPD) was performed in 303 patients with pancreatic adenocarcinoma; 35 of these underwent partial PV/SMV resection. Applying a previously reported CDI score, we evaluated the integrity of the echogenic border layer between the vein and tumor (mural demarcation) and maximum blood flow velocity (V (max)) in the PV segment in contact with the tumor. The results were compared to the final histological findings in the resected venous walls.
CDI findings correlated well with the histological invasion grades. By measuring V (max )and evaluating mural demarcation, we observed a sensitivity of 66.7% and 100% and a specificity of 98.3% and 93.9%, respectively, in predicting full thickness vein invasion, including the intima. V (max) above 80 cm/s and lack of mural demarcation were predictors of PV/SMV invasion. The postoperative survival rates depended on the depth of tumor infiltration into the PV/SMV.
Modern CDI is a reliable and valid technique for evaluation of morphological and hemodynamic parameters in the portal vein segment adjacent to pancreatic adenocarcinoma. Maximal blood-flow velocity in the portal segment in contact with the tumor and absence of the echogenic vessel-parenchymal sonographic interface are parameters predictive of tumor infiltration of the portal intima.
胰腺腺癌侵犯门静脉（PV）和肠系膜上静脉（SMV）内膜传统上被视为不宜行手术切除及预后不良的标准。本研究旨在评估现代彩色双功成像（CDI）对胰腺腺癌侵犯PV/SMV的评估价值。
1994年至2005年，对303例胰腺腺癌患者施行Whipple手术或保留幽门的胰十二指肠切除术（PPPD）；其中35例行部分PV/SMV切除。应用先前报道的CDI评分，我们评估了静脉与肿瘤之间强回声边界层的完整性（壁分界）以及与肿瘤接触的PV段的最大血流速度（V（max））。将结果与切除静脉壁的最终组织学结果进行比较。
CDI表现与组织学浸润分级密切相关。通过测量V（max）并评估壁分界，我们在预测包括内膜在内的静脉全层侵犯时，观察到敏感性分别为66.7%和100%，特异性分别为98.3%和93.9%。V（max）高于80 cm/s且缺乏壁分界是PV/SMV侵犯的预测指标。术后生存率取决于肿瘤浸润PV/SMV的深度。
现代CDI是评估胰腺腺癌邻近门静脉段形态学和血流动力学参数的可靠且有效的技术。与肿瘤接触的门静脉段的最大血流速度以及无强回声血管-实质超声界面是预测门静脉内膜肿瘤浸润的参数。
