实时弹性成像对胰十二指肠切除术后胰瘘的预测价值
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摘要
目的探讨实时弹性成像(SWE)技术检测胰腺组织弹性来预测胰瘘的风险,通过检测胰体部的SWE水平来衡量胰腺硬度,以减少胰十二指肠切除术后胰瘘的发生。方法回顾性分析2017年10月-2019年2月山东省滨州医学院附属医院收治的53例胰十二指肠切除术(PD)患者的临床资料。53例中10例PD术后发生胰瘘(胰瘘组),43例未发生(非胰瘘组)。应用超声中的SWE技术检测胰体部位的弹性值,反应胰腺的组织弹性,评估胰腺的硬度。计量资料两组间比较采用t检验,计数资料组间比较采用χ~2检验。单因素分析采用logistic回归分析,Spearman相关系数被用来检验SWE和其他实验室数据的相关性。结果 BMI(t=1. 321)、术前总胆红素(t=1. 347)、主胰管直径(t=1. 385)、SWE最大值(t=1. 728)、SWE平均值(t=1. 634)、术中胰腺软硬(χ~2=4. 983)是胰瘘的风险因素(P值均<0. 05)。SWE最大值和SWE平均值与年龄、手术时间均呈负相关(最大值:r值分别为-0. 329、-0. 260,P值均<0. 05;平均值:r值分别为-0. 282、-0. 282,P值均<0. 05),与BMI均呈正相关(r值分别为0. 275、0. 350,P值均<0. 05)。结论 SWE水平是PD后胰瘘的独立危险因素,胰体部SWE水平对PD术后胰瘘具有高度预测价值,对患者行手术治疗具有指导意义。
Objective Objective To investigate the value of pancreatic elasticity based on shear wave elastography( SWE) in predicting the risk of pancreatic fistula,to measure pancreatic hardness by determining the SWE level of the pancreatic body,and to reduce the development of pancreatic fistula after pancreaticoduodenectomy. Methods A retrospective analysis was performed for the clinical data of 53 patients who were admitted to The Affiliated Hospital of Binzhou Medical University from October 2017 to February 2019 and underwent pancreaticoduodenectomy( PD). The 53 patients were divided into pancreatic fistula group with 10 patients who developed pancreatic fistula after PD and non-pancreatic fistula group with 43 patients who did not develop this disease after PD. The elasticity value of the pancreatic body measured by SWE was used to reflect the tissue elasticity of the pancreas and evaluate the hardness of the pancreas. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used for univariate analysis,and the Spearman's correlation coefficient was used to investigate the correlation between SWE and other laboratory data. Results Body mass index( BMI)( t = 1. 321),preoperative total bilirubin( t = 1. 347),diameter of the main pancreatic duct( t = 1. 385),maximum SWE value( t = 1. 728),mean SWE value( t = 1. 634),and intraoperative pancreatic hardness( χ~2= 4. 983) were risk factors for pancreatic fistula( all P < 0. 05). Maximum SWE value and mean SWE value were negatively correlated with age and time of operation( maximum SWE value: r =-0. 329 and-0. 260,both P < 0. 05; mean SWE value: r =-0. 282,and-0. 282,both P < 0. 05) and positively correlated with BMI( r = 0. 275 and 0. 350,both P < 0. 05). Conclusion SWE level is an independent risk factor for pancreatic fistula after pancreaticoduodenectomy,and the SWE level of the pancreatic body has a high predictive value and guiding significance in surgical treatment.
Objective Objective To investigate the value of pancreatic elasticity based on shear wave elastography( SWE) in predicting the risk of pancreatic fistula,to measure pancreatic hardness by determining the SWE level of the pancreatic body,and to reduce the development of pancreatic fistula after pancreaticoduodenectomy. Methods A retrospective analysis was performed for the clinical data of 53 patients who were admitted to The Affiliated Hospital of Binzhou Medical University from October 2017 to February 2019 and underwent pancreaticoduodenectomy( PD). The 53 patients were divided into pancreatic fistula group with 10 patients who developed pancreatic fistula after PD and non-pancreatic fistula group with 43 patients who did not develop this disease after PD. The elasticity value of the pancreatic body measured by SWE was used to reflect the tissue elasticity of the pancreas and evaluate the hardness of the pancreas. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used for univariate analysis,and the Spearman's correlation coefficient was used to investigate the correlation between SWE and other laboratory data. Results Body mass index( BMI)( t = 1. 321),preoperative total bilirubin( t = 1. 347),diameter of the main pancreatic duct( t = 1. 385),maximum SWE value( t = 1. 728),mean SWE value( t = 1. 634),and intraoperative pancreatic hardness( χ~2= 4. 983) were risk factors for pancreatic fistula( all P < 0. 05). Maximum SWE value and mean SWE value were negatively correlated with age and time of operation( maximum SWE value: r =-0. 329 and-0. 260,both P < 0. 05; mean SWE value: r =-0. 282,and-0. 282,both P < 0. 05) and positively correlated with BMI( r = 0. 275 and 0. 350,both P < 0. 05). Conclusion SWE level is an independent risk factor for pancreatic fistula after pancreaticoduodenectomy,and the SWE level of the pancreatic body has a high predictive value and guiding significance in surgical treatment.
引文
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[18]DESMOTS F,FAKHRY N,MANCINI J,et al.Shear wave elastography inhead neck lymphnodeassessment:Image quality and diagnostic impact compared with B-Mode and Doppler ultrasonography[J].Ultrasound Med Biol,2016,42(2):387-398.
[19]PARK AY,SON EJ,HAN K,et al.Shear wave elastography of thyroid nodules for the prediction of malignancy in a large scale study[J].Eur J Radiol,2015,84(3):407-412.
[20]MOU YL,CAO JY,LI ZY,et al.Real-time shear wave elastography in quantitative differential diagnosis of thyroid nodule[J].Chin J Med Offic,2018,46(9):1030-1032.(in Chinese).牟泳霖,曹军英,里子彧,等.实时剪切波弹性成像技术对甲状腺良恶性结节鉴别研究[J].临床军医杂志,2018,46(9):1030-1032.
[21]SONG PF,MELLEMA DC,SHEEDY SP,et al.Performation of2-dimensional ultrasound shear wave elastography in liver fibrosis detection using magnetic resonance elastography as the reference standard a pilot study[J].Ultra Med,2016,32(2):401-412.
[22]LEE EJ,JUNG HK,KO KH,et al.Diagnostic performances of shear wave elastography:Which parameter to use in differential diagnosis of solid breast masses?[J].Eur Radiol,2013,23:1803-1811.
[23]ZHU YC,ZHANG Y,DENG SH,et al.Correlation between histopathological grading and shear-wave elastography in evaluating invasive carcinoma of no special type[J].Exp T-her Med,2018,16(6):4700-4706.
[24]HARI S,PAUL SB,VIDYASAGAR R,et al.Breast mass characterization using shear wave elastography and ultrasound[J].Diagn Interv Imaging,2018,99(11):699-707.
[25]DURMAZ MS,SIVRI M,SEKMENLI T,et al.Experience of using shear wave elastography imaging in evaluation of undescended testes in children:Feasibility,reproducibility,and clinical potential[J].Ultrasound Q,2018,34(4):206-212.
[26]PALUCH L,NOSZCZYK B,NITEK Z·,et al.Shear-wave elastography:A new potential method to diagnose ulnar neuropathy at the elbow[J].Eur Radiol,2018,28(12):4932-4939.
[27]KOC AS,SUMBUL HE.Sumbul,Renal cortical stiffness obtained by shear wave elastography imaging is increased in patients with type 2 diabetes mellitus without diabetic nephropathy[J].J Ultrasound,2018,21(4):279-285.
[28]GUO R,XIANG X,QIU L.Shear-wave elastography assessment of gluteal muscle contracture:Three case reports[J].Medicine(Baltimore),2018,97(44):13071.
[29]LEE TK,KANG CM,PARK MS,et al.Prediction of postoperative pancreatic fstulas after pancreatectomy:Assessment with acoustic radiation force impulse elastography[J].J Ultrasound Med,2014,33:781-786.
[30]WU B,CHEN YY,CHEN XJ,et al.Value of endoscopic ultrasonography in diagnosis of pancreatic space-occupying diseases[J].J Clin Hepatol,2018,34(8):1723-1727.(in Chinese)吴斌,沈亦钰,陈徐艰,等.超声内镜在胰腺占位性疾病诊断中的价值[J].临床肝胆病杂志,2018,34(8):1723-1727.
[2]XIANG Y,XU MQ,YAN LN,et al.Correlation study of pancreatic leakage and anastomotic bleeding in pancreaticojejunostomy after pancreaticoduodenectomy[J].Chin J Bases Clin Gen Surg,2013,20(5):503-507.(in Chinese)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.
[3]GOU SM,WU HS.Developmental history of the extent of lymphnode dissection in pancreatic cancer surgery[J].J Clin Hepatol,2017,33(1):57-60.(in Chinese)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.
[4]BERCOFF J,TANTER M,FINK M,et al.Supersonic shear imaging:A new technique for soft tissue elasticity mapping[J].IEEE Trans Ultrason Ferroelectr Freq Control,2004,51(4):396-409.
[5]SARVAZYAN AP,RUDENKO OV,SWANSON SD,et al.Shear wave elasticity imaging:A new ultrasonic technology of medical diagnostics[J].Ultrasound Med Biol,1998,24(29):1419-1435.
[6]BASSI C,MARCHEGIANI G,DERVENIS C,et al.The 2016update of the International Study Group(ISGPS)definition and grading of postoperative pancreatic fistula:11 years after[J].Surge,2017,161(3):584-591.
[7]DOBRUCH-SOBCZAK K,ZALEWSKA EB,GUMIN'SKA A,et al.Diagnostic performance of shear wave elastography parameters alone and in combination with conventional b-mode ultrasound parameters for the characterization of thyroid nodules:A prospective,dual-center study[J].Ultrasound Med Biol,2016,42(12):2803-2811.
[8]CHEN M,ZHANG KQ,XU YF,et al.Shear wave elastography and contrast-enhanced ultrasonography in the diagnosis of thyroid malignant nodules[J].Mol Clin Oncol,2016,5(6):724-730.
[9]HU BY,WAN T,ZHANG WZ,et al.Risk factors for postoperative pancreatic fistula:Analysis of 539 successive cases of pancreaticoduodenectomy[J].World J Gastroenterol,2016,22(34):7797-7805.
[10]FANG CH,CHEN QS,YANG J,et al.Body mass index and stump morphology predict an increased incidence of pancreatic fistula after pancreaticoduodenectomy[J].World J Surg,2016,40(6):1467-1476.
[11]DU HP,CHEN W,HUANG L,et al.Risk factors analysis of pancreatic fistula after pancreaticoduodenectomy[J].Chin JDig Surg,2018,17(7):724-728.(in Chinese)杜汉朋,陈伟,黄力,等.胰十二指肠切除术后胰瘘发生的危险因素分析[J].中华消化外科杂志,2018,17(7):724-728.
[12]ANSORGE C,STROMMER L,ANDREN-SANDBERG,et al.Structured intraoperative assessment of pancreatic gland characteristics in predicting complications after pancreaticoduodenectomy[J].Br J Surg,2012,99(8):1076-1082.
[13]EI NAKEEB A,SALAH T,SULTAN A,et al.Pancreatic anastomotic leakage after pancreaticoduodenectomy.Risk factors,clinical predictors,and management(single center experience)[J].World Journal of Surgery,2013,37(6):1405-1418.
[14]SUGIMOTO M,TAKAHASHI S,KOJIMA M,et al.In Patients with a soft pancreas,a thick parenchyma,a small duct,and fatty infiltration are significant risks for pancreatic fistula after pancreaticoduodenectomy[J].J Gastrointest Surg,2017,21(5):846-854.
[15]PRAN WB,CALLERY MP.Risk prediction for development of pancreatic fistula using the ISGPF classification scheme[J].World J Surg,2008,32(3):419-428.
[16]ARANHA GV,AARON JM,SHOUP M,et al.Current management of pancreatic fistula after pancreaticoduodenectomy[J].Surgery,2006,140(4):561.
[17]LIU FJ,YANG Q,ZHANG Q,et al.Real-time tissue elastography for the detection of vulnerable carotid plaques in patients undergoing endarterectomy:A pilot study[J].Ultrasound Med Biol,2015,41(3):705-712.
[18]DESMOTS F,FAKHRY N,MANCINI J,et al.Shear wave elastography inhead neck lymphnodeassessment:Image quality and diagnostic impact compared with B-Mode and Doppler ultrasonography[J].Ultrasound Med Biol,2016,42(2):387-398.
[19]PARK AY,SON EJ,HAN K,et al.Shear wave elastography of thyroid nodules for the prediction of malignancy in a large scale study[J].Eur J Radiol,2015,84(3):407-412.
[20]MOU YL,CAO JY,LI ZY,et al.Real-time shear wave elastography in quantitative differential diagnosis of thyroid nodule[J].Chin J Med Offic,2018,46(9):1030-1032.(in Chinese).牟泳霖,曹军英,里子彧,等.实时剪切波弹性成像技术对甲状腺良恶性结节鉴别研究[J].临床军医杂志,2018,46(9):1030-1032.
[21]SONG PF,MELLEMA DC,SHEEDY SP,et al.Performation of2-dimensional ultrasound shear wave elastography in liver fibrosis detection using magnetic resonance elastography as the reference standard a pilot study[J].Ultra Med,2016,32(2):401-412.
[22]LEE EJ,JUNG HK,KO KH,et al.Diagnostic performances of shear wave elastography:Which parameter to use in differential diagnosis of solid breast masses?[J].Eur Radiol,2013,23:1803-1811.
[23]ZHU YC,ZHANG Y,DENG SH,et al.Correlation between histopathological grading and shear-wave elastography in evaluating invasive carcinoma of no special type[J].Exp T-her Med,2018,16(6):4700-4706.
[24]HARI S,PAUL SB,VIDYASAGAR R,et al.Breast mass characterization using shear wave elastography and ultrasound[J].Diagn Interv Imaging,2018,99(11):699-707.
[25]DURMAZ MS,SIVRI M,SEKMENLI T,et al.Experience of using shear wave elastography imaging in evaluation of undescended testes in children:Feasibility,reproducibility,and clinical potential[J].Ultrasound Q,2018,34(4):206-212.
[26]PALUCH L,NOSZCZYK B,NITEK Z·,et al.Shear-wave elastography:A new potential method to diagnose ulnar neuropathy at the elbow[J].Eur Radiol,2018,28(12):4932-4939.
[27]KOC AS,SUMBUL HE.Sumbul,Renal cortical stiffness obtained by shear wave elastography imaging is increased in patients with type 2 diabetes mellitus without diabetic nephropathy[J].J Ultrasound,2018,21(4):279-285.
[28]GUO R,XIANG X,QIU L.Shear-wave elastography assessment of gluteal muscle contracture:Three case reports[J].Medicine(Baltimore),2018,97(44):13071.
[29]LEE TK,KANG CM,PARK MS,et al.Prediction of postoperative pancreatic fstulas after pancreatectomy:Assessment with acoustic radiation force impulse elastography[J].J Ultrasound Med,2014,33:781-786.
[30]WU B,CHEN YY,CHEN XJ,et al.Value of endoscopic ultrasonography in diagnosis of pancreatic space-occupying diseases[J].J Clin Hepatol,2018,34(8):1723-1727.(in Chinese)吴斌,沈亦钰,陈徐艰,等.超声内镜在胰腺占位性疾病诊断中的价值[J].临床肝胆病杂志,2018,34(8):1723-1727.