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目的探讨建立胰腺钩突部肿瘤累及肠系膜上静脉(SMV)的程度及临床分级,以指导临床医生术前评估和手术方案的制定。方法根据薄层增强CT及计算机辅助X线断层摄影术(CTA)的检查结果,对143例胰腺钩突部肿瘤累及SMV的患者进行临床分级,即T分级,分别为T1级(界限清楚型)、T2级(界限模糊型)、T3级(界限消失型)和T4级(界限“渗透”型,又称血管侵犯型)。分析术前T分级和手术中实际分级(S分级)的一致性。结果T分级中4种不同的临床分级与所选择的手术方式有明显差别,T1级和T2级胰腺钩突部肿瘤累及SMV的手术切除率分别为100%和97.4%,T3级和T4级分别为65.8%和21.7%。术前T分级与S分级具有一致性(U=15.96,P<0.01)。结论对胰腺钩突部肿瘤累及SMV的程度进行临床分级,有助于指导临床医生准确判断胰腺钩突部肿瘤的解剖特点及制定更为合理的手术方案。
Objective To investigate the extent and clinical classification of the superior mesenteric vein (SMV) involved in the development of the pancreatic uncinate process in order to guide clinicians in preoperative evaluation and surgical planning. Methods According to the results of thin-slice contrast-enhanced CT and computed tomography (CTA), 143 patients with SMV in pancreatic uncinate process were classified into T grade (T1 grade) , T2 (fuzzy boundary), T3 (disappeared boundary) and T4 (boundary “infiltration” type, also known as vascular invasion). Analysis of preoperative T grade and surgery in the actual classification (S grade) consistency. Results Four different clinical grades of T grade were significantly different from the surgical methods selected. Surgical resection rates of T1-grade and T2 grade pancreatic uncinate tumors involving SMV were 100% and 97.4%, respectively 65.8% and 21.7%. Preoperative T grade and S grade consistent (U = 15.96, P <0.01). Conclusions The clinical classification of the extent of involvement of SMV in the uncinate process of the pancreas helps clinicians to accurately determine the anatomical features of the pancreatic uncinate process and to develop a more rational surgical plan.