RESUMEN
Objective:To explore the application value of three-dimensional visualization technology in the analysis of anatomic variation of peripancreatic vessels in patients with pancreatic space occupation.Methods:A total of 98 cases in Yijishan Hospital of Wannan Medical College, the First Affiliated Hospital of University of Science and Technology of China, the First Affiliated Hospital of Anhui Medical University, the Second Affiliated Hospital of Anhui Medical University, the First Affiliated Hospital of Bengbu Medical College, Fuyang People's Hospital from June 2018 to December 2019 were retrospectively analyzed. Of 94 patients were enrolled, including 56 males and 38 females, aged (61.2±7.2) years. Abdominal organs and blood vessels were reconstructed by 3D visualization technology, and anatomic variation of peripancreatic vessels was analyzed, including abdominal trunk, hepatic artery system, portal vein system and dorsal pancreatic artery.Results:The three-dimensional reconstruction rate of celiac trunk vessels was 100.0% (94/94). The 60 cases of abnormal celiac trunk were as follows: liver and spleen trunk in 5 cases (5.3%), stomach and spleen trunk in 1 case (1.1%), liver, stomach and spleen mesentery trunk in 3 cases (3.2%), liver, stomach and spleen mesentery trunk in 17 cases (18.1%), celiac trunk with one or more inferior phrenic arteries in 34 cases (36.2%). There were 69 cases (73.4%) of Michels type Ⅰ, 2 cases (2.1%) of Michels type Ⅲ, 1 case (1.1%) of Michels Ⅴ, 2 cases (2.1%) of Ⅷ, and 1 case (1.1%) of type Ⅸ of hepatic artery system. There were 17 cases (18.1%) of accessory left hepatic artery from celiac trunk which did not belong to Michels classification. Left accessory hepatic artery originated from left gastric artery and left hepatic artery originated from superior mesenteric artery in 1 case (1.1%), right accessory hepatic artery originated from celiac trunk combined with proper hepatic artery and right anterior hepatic artery combined with gastroduodenal artery originated from right posterior hepatic artery in 1 case (1.1%). Abnormal walking of dorsal pancreatic artery in 3 cases. The inferior mesenteric vein flowed into the superior mesenteric vein in 38 cases (40.4%), and the inferior mesenteric vein flowed into the splenic vein and superior mesenteric vein in 4 cases (4.3%).Conclusion:Three-dimensional visualization technique is helpful to determine the variation of peripancreatic vessels, and has certain significance for accurate preoperative evaluation and surgical guidance of patients with pancreatic space occupation.
RESUMEN
Objective: To evaluate the role of 3-phase contrast-enhanced multidetector-row computed tomography (MDCT) in observing blood vessel invasion around the pancreas before operation and its value in assessing the resectibility of pancreatic carcinoma. Methods: The 3-phase contrast-enhanced MDCT scanning images of 25 patients with pancreatic carcinoma were retrospectively analyzed. The intensity difference in 3-phase contrast-enhanced MDCT scanning images between pancreatic carcinoma and normal pancreas and the involvement of major blood vessel were analyzed; the results were compared with those of operative finding. Results: Seventeen patients had pancreatic carcinomas at the head of pancreas, six at the body of pancreas, and two at the tail of pancreas. The diameters of pancreatic carcinomas were ≤2 cm in two patients, and the others with diameter >2 cm. All the 25 patients were surgically treated, 12 receiving pancreaticoduodenectomy and 13 receiving palliative surgery. Four (9 blood vessels)patients were misdiagnosed as unresectable and 3 (8 blood vessels)as resectable. The arterial phase of MDCT was helpful for observation of the blood vessel involvement and for performing computed tomographic arteriography (CTA), which can better assess the tumor invasion of arteries around the pancreas. The largest intensity difference between normal pancreas and pancreatic carcinomas was found during the pancreatic phase, making it easier to discover pancreatic carcinoma. The largest intensity difference between liver and metastatic tumor was found in the liver phase, making it easier for qualitative diagnosis. Conclusion: Three phase contrast-enhanced scanning with MDCT has great value for diagnosis of pancreatic carcinoma and for assessment of major blood vessel involvement. MDCT, together with other criteria, can help to assess the resectibility of tumor before operation.