Nerestyuk Ya I, Karmazanovsky G G, Kubyshkin V A, Krieger A G, Khairieva A V
Vishnevsky Institute of Surgery, Ministry of Health of the Russian Federation, Moscow, Russia.
Khirurgiia (Mosk). 2017(4):36-40. doi: 10.17116/hirurgia2017436-40.
To define the indications for pancreatoduodenectomy using 3D CT-imaging, to calculate the volume of damaged and intact tissues and to determine type of surgery depending on severity of disease in case of ductal pancreatic adenocarcinoma.
Retrospective analysis of CT-scans of 30 patients with ductal pancreatic adenocarcinoma was performed. In groups 1 and 2 by 15 patients total pancreatectomy and pancreatoduodenectomy were made respectively. All patients underwent contrast-enhanced CT examination (Brilliance iCT, Phillips) followed post-processing on Brilliance Workspace Portal platform. All data were assessed by two reviewers.
In group 1 CT volume of the tumor was 24±19 cm3 (32% of total pancreas), in group 2 - 9.8±6 cm3 (16% of total pancreas). CT-volume of celiacomesenteric arteries and portal system was 25.8±10 mm/59.5±18.9 mm and 23.3±6/49.9±14.7 mm in groups 1 and 2 respectively. Greater volume of tumor was significantly associated with increased portal system (p<0.03). Sensitivity, specificity and accuracy of determining of tumor location were increased up to 94%, 50% and 80% respectively in group 1. There were no cases of wrong localization in group 2. Data of both reviewers were similar.
Total pancreatectomy is advisable for pancreatic adenocarcinoma if its volume is over 31.8% of total pancreas according to 3D CT-scans. 3D-modeling improves preoperative assessment of resectability, accuracy of determining of tumor localization and identifying vascular invasion.
利用三维CT成像确定胰十二指肠切除术的适应证，计算受损和完整组织的体积，并根据导管腺癌的疾病严重程度确定手术类型。
对30例导管腺癌患者的CT扫描进行回顾性分析。第1组和第2组分别有15例患者，分别进行了全胰切除术和胰十二指肠切除术。所有患者均接受了对比增强CT检查（飞利浦Brilliance iCT），随后在Brilliance Workspace Portal平台上进行后处理。所有数据由两名审阅者评估。
第1组肿瘤的CT体积为24±19 cm³（占胰腺总体积的32%），第2组为9.8±6 cm³（占胰腺总体积的16%）。第1组和第2组腹腔肠系膜动脉和门静脉系统的CT体积分别为25.8±10 mm/59.5±18.9 mm和23.3±6/49.9±14.7 mm。肿瘤体积越大与门静脉系统增加显著相关（p<0.03）。第1组中肿瘤定位的敏感性、特异性和准确性分别提高到94%、50%和80%。第2组没有定位错误的病例。两名审阅者的数据相似。
根据三维CT扫描，如果胰腺腺癌的体积超过胰腺总体积的31.8%，则建议进行全胰切除术。三维建模改善了术前对可切除性的评估、肿瘤定位的准确性以及血管侵犯的识别。
