Coombs R J, Zeiss J, Howard J M, Thomford N R, Merrick H W
Department of Radiology, Medical College of Ohio, Toledo 43699.
AJR Am J Roentgenol. 1990 May;154(5):1011-4. doi: 10.2214/ajr.154.5.2108534.
We performed a retrospective study of CT scans in 29 patients who had undergone the Whipple procedure (radical pancreaticoduodenectomy) to study the CT appearance of the postsurgical anatomy and assess the use of CT in the evaluation of early postoperative complications and recurrent tumor. In the postoperative period, the scans from 15 patients revealed seven transient fluid collections; four deep abscesses, three of which were successfully drained under CT guidance; three superficial abscesses; and five cases of ascites. In 19 patients, CT scans were obtained up to 4 years after surgery to search for recurrent tumor. The most frequent site of recurrence was the liver. CT correctly identified liver metastases in six of seven patients and was falsely positive in one. Recurrence also was found twice in retroperitoneal lymph nodes; one time each in the mesenteric root, spleen, and lung base; and twice causing afferent loop blockage. Surgical proof of recurrence was obtained in eight cases. Our experience suggests that an understanding of the normal postoperative anatomy following the Whipple procedure is essential in evaluating postoperative CT scans. Scans obtained for detection of tumor recurrence should be optimized for imaging the liver because this was the most frequent site of recurrence.
我们对29例行Whipple手术（根治性胰十二指肠切除术）的患者的CT扫描进行了回顾性研究，以了解术后解剖结构的CT表现，并评估CT在早期术后并发症及肿瘤复发评估中的应用。术后，15例患者的扫描显示有7例出现短暂性液体积聚；4例深部脓肿，其中3例在CT引导下成功引流；3例浅表脓肿；以及5例腹水。19例患者在术后长达4年的时间里进行了CT扫描以查找复发肿瘤。最常见的复发部位是肝脏。CT在7例患者中的6例正确识别出肝转移，1例假阳性。腹膜后淋巴结复发2次；肠系膜根部、脾脏和肺底各复发1次；2次复发导致输入袢梗阻。8例获得了复发的手术证据。我们的经验表明，了解Whipple手术后正常的术后解剖结构对于评估术后CT扫描至关重要。为检测肿瘤复发而进行的扫描应针对肝脏成像进行优化，因为肝脏是最常见的复发部位。
