Cunningham J D, Glajchen N, Brower S T
Department of Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.
Int J Pancreatol. 1996 Feb;19(1):9-14. doi: 10.1007/BF02788370.
Spiral CT allows for a noninvasive evaluation of the mesenteric arterial and venous vessels. This test can be performed quicker, with less expense, and with a reduced radiation and contrast load than angiography. Comparison studies of angiography and spiral CT are needed in patients with pancreatic cancer to determine the best method of evaluating possible vessel involvement.
Preoperative imaging of patients with pancreatic cancer is crucial in determining resectability and planning management. Computed tomography (CT) remains the diagnostic procedure of choice for the evaluation of the primary tumor and angiography is the gold standard to evaluate vessel encasement. This case evaluates the usefulness of spiral computed tomography in determining vessel encasement.
A 53-yr-old female presented with vague abdominal complaints and evaluation revealed a mass in the pancreas. CT suggested portal vein involvement and collateralization was noted in the upper abdomen. Spiral CT revealed normal arterial anatomy and near complete obstruction of the portal vein at the superior mesenteric vein (SMV) splenic vein (SV) confluence.
Operative findings confirmed the involvement of the portal vein at the confluence of the SMV and SV. Pancreatico-duodenectomy with portal vein resection and primary anastomosis was performed. The patient's postoperative course was uneventful and she was discharged home on the 13th postoperative day.
螺旋CT可对肠系膜动静脉血管进行无创评估。与血管造影相比，该检查实施速度更快、费用更低，且辐射和造影剂负荷更小。对于胰腺癌患者，需要进行血管造影和螺旋CT的对比研究，以确定评估可能的血管受累情况的最佳方法。
胰腺癌患者的术前影像学检查对于确定可切除性和规划治疗方案至关重要。计算机断层扫描（CT）仍然是评估原发性肿瘤的首选诊断方法，而血管造影是评估血管包绕情况的金标准。本病例评估了螺旋计算机断层扫描在确定血管包绕方面的实用性。
一名53岁女性因腹部隐痛就诊，检查发现胰腺有肿块。CT提示门静脉受累，上腹部可见侧支循环形成。螺旋CT显示动脉解剖结构正常，肠系膜上静脉（SMV）与脾静脉（SV）汇合处门静脉近乎完全阻塞。
手术结果证实SMV与SV汇合处的门静脉受累。实施了胰十二指肠切除术，同时进行门静脉切除和一期吻合。患者术后恢复顺利，术后第13天出院。
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