切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (06) : 646 -650. doi: 10.3877/cma.j.issn.2095-3232.2023.06.011

临床研究

术中胰腺超声弹性成像在胰腺质地评估中的应用
杨天池, 韩威†(), 邱枫, 祁佳慧   
  1. 101100　首都医科大学附属北京潞河医院普通外科
  • 收稿日期:2023-09-04 出版日期:2023-12-10
  • 通信作者: 韩威

Evaluation of pancreatic texture by intraoperative ultrasonic elastography

Tianchi Yang, Wei Han†(), Feng Qiu, Jiahui Qi   

  1. Department of General Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101100, China
  • Received:2023-09-04 Published:2023-12-10
  • Corresponding author: Wei Han
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

杨天池, 韩威, 邱枫, 祁佳慧. 术中胰腺超声弹性成像在胰腺质地评估中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 646-650.

Tianchi Yang, Wei Han, Feng Qiu, Jiahui Qi. Evaluation of pancreatic texture by intraoperative ultrasonic elastography[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 646-650.

目的

探讨术中胰腺超声弹性成像在胰腺质地评估中的应用价值。

方法

回顾性分析2019年9月至2020年7在首都医科大学附属北京潞河医院行术中胰腺剪切波弹性成像（SWE）检查的19例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男8例，女11例；年龄58~76岁，中位年龄66岁。根据原发病不同分为壶腹周围肿瘤组（10例）和对照组（9例）。术中超声检测患者胰颈部SWE杨氏模量值，探索胰腺SWE杨氏模量值范围；分析术中胰腺SWE杨氏模量值与术前胰腺CT值的相关性。相关性分析采用Spearman相关。

结果

患者术中胰腺SWE杨氏模量值的中位数为13.4（11.5，17.7）kPa，其中壶腹周围肿瘤组为16.0（11.4，19.2）kPa，对照组为13.2（11.5，15.6）kPa，差异无统计学意义（Z=-0.164，P=0.905）。术前胰腺平扫CT值为34±12，术中胰腺SWE值与平扫CT值呈负相关（rs=-0.555，P=0.014）。

结论

术中胰腺SWE杨氏模量值可尝试作为量化胰腺质地的指标，初步判断胰腺质地。

关键词: 胰腺质地, 超声检查, 实时弹性成像, 胰腺CT值
Objective

To evaluate the application value of intraoperative ultrasonic elastography in the evaluation of pancreatic texture.

Methods

Clinical data of 19 patients who underwent intraoperative shear-wave elastography (SWE) examination in Beijing Luhe Hospital Affiliated to Capital Medical University from September 2019 to July 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 8 patients were male and 11 female, aged from 58 to 76 years, with a median age of 66 years. According to different primary diseases, all patients were divided into periampullary tumor group (n=10) and control group (n=9). Young's modulus of the pancreatic neck by SWE was detected by intraoperative ultrasound, and the range of Young's modulus of pancreatic SWE was investigated. The correlation between intraoperative Young's modulus of pancreas by SWE and preoperative pancreatic CT value was analyzed. Correlation analysis was performed by Spearman's correlation analysis.

Results

The median value of intraoperative Young's modulus of pancreatic SWE was 13.4(11.5, 17.7) kPa, including 16.0(11.4, 19.2) kPa in the periampullary tumor group and 13.2(11.5, 15.6) kPa in the control group. The difference was not statistically significant (Z=-0.164, P=0.905). Preoperative plain CT scan value of the pancreas was 34±12, and intraoperative SWE value of the pancreas was negatively correlated with plain scan CT value (rs=-0.555, P=0.014).

Conclusions

Intraoperative Young's modulus of the pancreas by SWE can be utilized as an index to quantify and preliminarily assess the texture of pancreas.

Key words: Pancreatic texture, Ultrasonography, Shear wave elastography, CT value of pancreas
图1 术中超声测量胰颈部剪切波弹性成像杨氏模量值注：a示探头"压迫"胰腺；b示探头接触胰腺
表1 壶腹周围肿瘤组和对照组患者术中胰腺硬度检测及一般资料比较
组别 例数 年龄(岁，±s) 性别(例，男/女) BMI(kg/m2，±s) SWE杨氏模量值[kPa，M(Q1，Q3)]
壶腹周围肿瘤组 10 66±5 4/6 22.4±3.4 16.0(11.4，19.2)
对照组 9 66±6 4/5 24.9±3.7 13.2(11.5，15.6)
统计值   t=-0.165 - t=-1.552 Z=0.164
P值   0.871 0.845 0.139 0.905
图2 术中弹性成像结果与胰腺平扫CT值的相关性分析注：SWE为剪切波弹性成像杨氏模量值
[1]
Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65(2):87-108.
[2]
Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1):7-33.
[3]
Zhou Y, Zhang Z, Wu L, et al. A systematic review of safety and efficacy of hepatopancreatoduodenectomy for biliary and gallbladder cancers[J]. HPB, 2016, 18(1):1-6.
[4]
Ansorge C, Strömmer L, Andrén-Sandberg Å, et al. Structured intraoperative assessment of pancreatic gland characteristics in predicting complications after pancreaticoduodenectomy[J]. Br J Surg, 2012, 99(8):1076-1082.
[5]
D'Onofrio M, Tremolada G, De Robertis R, et al. Prevent pancreatic fistula after pancreatoduodenectomy: possible role of ultrasound elastography[J]. Dig Surg, 2018, 35(2):164-170.
[6]
Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after[J]. Surgery, 2017, 161(3):584-591.
[7]
向颖, 徐明清, 严律南, 等. 胰十二指肠切除术中胰肠吻合方式与术后胰瘘及吻合口出血的相关性研究[J]. 中国普外基础与临床杂志, 2013, 20(5):503-507.
[8]
勾善淼, 吴河水. 胰腺癌根治术淋巴结清扫范围的发展历程[J]. 临床肝胆病杂志, 2017, 33(1):57-60.
[9]
Diener MK, Rahbari NN, Fischer L, et al. Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis[J]. Ann Surg, 2008, 247(6):950-961.
[10]
Shi S, Liang C, Xu J, et al. The strain ratio as obtained by endoscopic ultrasonography elastography correlates with the stroma proportion and the prognosis of local pancreatic cancer[J]. Ann Surg, 2020, 271(3):559-565.
[11]
Dietrich CF, Bamber J, Berzigotti A, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (short version)[J]. Ultraschall Med, 2017, 38(4):377-394.
[12]
Berzigotti A, Ferraioli G, Bota S, et al. Novel ultra-sound-based methods to assess liver disease: the game has just begun[J]. Dig Liver Dis, 2018, 50(2):107-112.
[13]
Dietrich CF, Dong Y. Shear wave elastography with a new reliability indicator[J]. J Ultrason, 2016, 16(66):281-287.
[14]
Harada N, Ishizawa T, Inoue Y, et al. Acoustic radiation force impulse imaging of the pancreas for estimation of pathologic fibrosis and risk of postoperative pancreatic fistula[J]. J Am Coll Surg, 2014, 219(5):887-894; 887-894, e5.
[15]
Banafea O, Mghanga FP, Zhao J, et al. Endoscopic ultrasonography with fine-needle aspiration for histological diagnosis of solid pancreatic masses: a meta-analysis of diagnostic accuracy studies[J]. BMC Gastroenterol, 2016, 16(1):108.
[16]
Harada N, Yoshizumi T, Maeda T, et al. Preoperative pancreatic stifness by real-time tissue elastography to predict ancreatic fstula after pancreaticoduodenectomy[J]. Anticancer Res, 2017, 37(4):1909-1915.
[17]
李扬, 史亚波, 涂建华, 黄长文. 胰十二指肠切除术后胰瘘发生的危险因素及预防[J/OL].中华肝脏外科手术学电子杂志, 2023, 12(3):352-355.
[18]
Barreto SG, Shukla PJ. Different types of pancreatico-enteric anastomosis[J]. Transl Gastroenterol Hepatol, 2017(2):89.
[19]
Marchegiani G, Ballarin R, Malleo G, et al. Quantitative assessment of pancreatic texture using a durometer: a new tool to predict the risk of developing a postoperative fistula[J]. World J Surg, 2017, 41(11):2876-2883.
[20]
Lin Z, Tang B, Cai J, et al. Preoperative prediction of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy[J]. Eur J Radiol, 2021(139):109693.
[21]
Hashimoto Y, Sclabas GM, Takahashi N, et al. Dual-phase computed tomography for assessment of pancreatic fibrosis and anastomotic failure risk following pancreatoduodenectomy[J]. J Gastrointest Surg, 2011, 15(12):2193-2204.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[3] 朱连华, 费翔, 韩鹏, 姜波, 李楠, 罗渝昆. 高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 904-910.
[4] 张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 945-950.
[5] 陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 974-978.
[6] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[7] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[8] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 844-848.
[9] 张丽丽, 陈莉, 余美琴, 聂小艳, 王婧玲, 刘婷. PDCA循环法在超声浅表器官亚专科建设中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 717-721.
[10] 罗刚, 泮思林, 陈涛涛, 许茜, 纪志娴, 王思宝, 孙玲玉. 超声心动图在胎儿心脏介入治疗室间隔完整的肺动脉闭锁中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 605-609.
[11] 黄佳, 石华, 张玉国, 胡佳琪, 陈茜. 胎儿左头臂静脉正常与异常超声图像特征及其临床意义[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 610-617.
[12] 袁泽, 庄丽. 超声检测胎儿脐动脉和大脑中动脉血流对胎儿宫内窘迫的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 618-621.
[13] 蒋佳纯, 王晓冰, 陈培荣, 许世豪. 血清学指标联合常规超声及超声造影评分诊断原发性干燥综合征的临床价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 622-630.
[14] 孔博, 张璟, 吕珂. 超声技术在复杂腹壁疝诊治中的作用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 670-673.
[15] 廖梅, 张红君, 金洁玚, 吕艳, 任杰. 床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 630-634.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号