Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
J Surg Res. 2010 Jan;158(1):53-60. doi: 10.1016/j.jss.2008.08.022.
This study reports the first results of durometrically measured hardness of human pancreas and investigates its correlation to palpatory determined hardness, grade of pancreatic fibrosis, and preoperatively determined radiodensity.
Fifty-two patients with pancreatic resections were prospectively recruited. Hardness of samples from pancreatic cancer, chronic pancreatitis, and normal pancreas was measured using a durometer on a 0-100 Shore units (SU) scale. Three pancreatic surgeons palpated the pancreas and reported their assessment of hardness on a subjective 0-100 "Bochum units" (BU) scale. Radiodensity and fibrosis of pancreatic tissue were used for comparison.
Pancreatic hardness differed significantly in normal pancreas, chronic pancreatitis, and pancreatic cancer; 30 SU, 51 SU, and 65.8 SU, respectively. Palpatory hardness of normal pancreas was 20 BU and of pancreatitis 60 BU. It correlated well to durometric readings: r(2)=0.56, P<0.00001. Fibrosis grade and radiodensity correlated neither to durometry nor to palpation. Pancreatic leak developed 4/20 (20%) patients with normal pancreas vs. 1/32 (3.1%) with chronic pancreatitis in the resection margin, P<0.05.
Palpatory assessment of pancreatic hardness performed by experienced surgeons correlated well to durometric measurements and remains the method of choice for intraoperative decision making. Durometry was more precise and should be considered in studies on pancreatic texture and for teaching purposes. Hardness and fibrosis grade appeared to be independent characteristics of pancreatic texture.
本研究报告了首例通过硬度计测量人胰腺硬度的结果，并探讨了其与触诊硬度、胰腺纤维化程度和术前放射密度的相关性。
前瞻性招募了 52 例接受胰腺切除术的患者。使用硬度计在 0-100 肖氏单位（Shore units，SU）刻度上测量来自胰腺癌、慢性胰腺炎和正常胰腺的样本的硬度。三位胰腺外科医生触诊胰腺，并在主观的 0-100“波鸿单位”（Bochum units，BU）量表上报告他们对硬度的评估。比较了胰腺组织的放射密度和纤维化程度。
正常胰腺、慢性胰腺炎和胰腺癌的胰腺硬度差异显著；分别为 30 SU、51 SU 和 65.8 SU。正常胰腺的触诊硬度为 20 BU，胰腺炎为 60 BU。它与硬度计读数相关性良好：r²=0.56，P<0.00001。纤维化程度和放射密度与硬度计和触诊均无相关性。在切缘处，正常胰腺的胰腺漏发生 4/20（20%）例，慢性胰腺炎为 1/32（3.1%），P<0.05。
经验丰富的外科医生触诊评估胰腺硬度与硬度计测量相关性良好，仍然是术中决策的首选方法。硬度计更精确，应考虑用于胰腺质地的研究和教学目的。硬度和纤维化程度似乎是胰腺质地的独立特征。
