Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Abdom Radiol (NY). 2018 Feb;43(2):476-488. doi: 10.1007/s00261-017-1378-y.
Pancreatic ductal adenocarcinoma is one of the leading causes of cancer-related deaths. With surgical resection being the only definitive treatment, improvements in technique has led to an increase in number of candidates undergoing resection by inclusion of borderline resectable disease patients to the clearly resectable group. Post-operative complications associated with pancreaticoduodenectomy and distal pancreatectomy include delayed gastric emptying, anastomotic failures, fistula formation, strictures, abscess, infarction, etc. The utility of dual-phase CT with multiplanar reconstruction and 3D rendering is increasingly recognized as a tool for the assessment of complications associated with vascular resection and reconstruction such as hemorrhage, pseudoaneurysm, vascular thrombosis, and ischemia. Prompt recognition of the complications and distinction from benign post-operative findings such as hepatic steatosis and mesenteric fat necrosis on imaging plays a key role in helping decrease the morbidity and mortality associated with surgery. We discuss, with case examples, some of such common and uncommon findings on imaging to familiarize the abdominal radiologists evaluating post-operative imaging in both acute and chronic post-operative settings.
胰腺导管腺癌是癌症相关死亡的主要原因之一。由于手术切除是唯一的根治性治疗方法，技术的改进导致可切除性边缘疾病患者纳入明确可切除组，从而增加了接受切除术的患者数量。胰十二指肠切除术和胰体尾切除术相关的术后并发症包括胃排空延迟、吻合口失败、瘘管形成、狭窄、脓肿、梗死等。随着多平面重建和 3D 渲染的双期 CT 的应用日益广泛，其已被认为是评估血管切除和重建相关并发症（如出血、假性动脉瘤、血管血栓形成和缺血）的一种工具。及时识别并发症并将其与良性术后表现（如肝脂肪变性和肠系膜脂肪坏死）在影像学上进行区分，对于降低与手术相关的发病率和死亡率至关重要。我们将通过病例示例讨论一些常见和不常见的影像学表现，以便熟悉评估急性和慢性术后情况的腹部放射科医生。
