【摘要】 目的探讨胰头癌患者肠系膜上动脉(superior mesenteric artery,SMA)在腹部增强CT的边界特征与分布在SMA周围的胰头神经丛第Ⅱ部(plexus pancreaticus capitalisⅡ,PPC-Ⅱ)中副交感神经增生之间的关系。方法选取2016年1~12月22例胰头癌由我科同一手术医师组施行开腹根治性胰十二指肠切除术,分析术前腹部增强CT SMA的边界特征,对PPC-Ⅱ行HE和免疫组化染色,观察SMA的影像学边界特征与PPC-Ⅱ中副交感神经增生、神经侵犯等神经病变的关系。结果 SMA在腹部增强CT中表现为不同的边界特征。以-20 Hu为界,根据SMA周围软组织在动脉期CT值将患者分为SMA边界清晰组和SMA边界毛糙组。SMA边界清晰组PPC-Ⅱ中副交感神经纤维数为(14.8±4.0)条,明显少于SMA边界毛糙组为(29.2±16.1)条(t=-2.610,P=0.017)。2组肿瘤分化程度(P=0.027)、术后早期(6个月)病死率(P=0.046)存在显著差异,SMA边界毛糙组低分化腺癌、术后早期死亡患者比例更高。结论 SMA在腹部增强CT中的边界特征可能与PPC-Ⅱ中副交感神经增生程度有关。毛糙边界可能预示着更活跃的副交感神经增生现象,且与胰头癌术后早期死亡风险有关。更多还原

【Abstract】 Objective To investigate the relationship between the boundary patterns of superior mesenteric artery( SMA) in abdominal enhanced CT and the parasympathetic neurogenesis in the plexus pancreaticus capitalis Ⅱ( PPC-Ⅱ) tissues around SMA in pancreatic head carcinoma. Methods From January 2016 to December 2016,22 patients diagnosed with pancreatic head carcinoma underwent radical pancreticoduodenectomy by a single surgeon team. The SMA boundary patterns in enhanced CT were analyzed. The PPC-Ⅱ tissues were collected and disposed for the HE staining and immunohistochemistry staining prospectively. Then we compared the correlation between the SMA boundary patterns and the pathological characteristics of PPC-Ⅱ such as the parasympathetic neurogenesis and the neural invasion. Results The SMA presented different boundary patterns in abdominal enhanced CT in pancreatic head adenocarcinoma. Based on -20 Hu as the partition value,the patients were classified into the clear boundary group and the obscure boundary group according to the CT value of soft tissues around SMA in arterial phase. The number of parasympathetic nerve fibers in the obscure SMA boundary group( 29. 2 ± 16. 1 fibers) was larger than that in the clear SMA boundary group [( 14. 8 ±4. 0) fibers,t =-2. 610,P = 0. 017]. The tumor differentiation( P = 0. 027) and the postoperative early mortality( P = 0. 046) also differed significantly in different groups. The patients with obscure SMA boundary were more likely to have poor differentiation and high postoperative early mortality. Conclusions The SMA boundary patterns in abdominal enhanced CT are possibly related with the degree of the parasympathetic neurogenesis in PPC-Ⅱ tissues. The obscure SMA boundary indicates a higher degree of parasympathetic neurogenesis and may be related with the postoperative early mortality in pancreatic head carcinoma.更多还原