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目的:探讨腰背痛症状对胰腺癌胰外神经侵犯的预测价值。方法:回顾性分析130例胰腺癌患者的临床及影像学资料。所有患者通过CT判断有无胰外神经侵犯,分析腰背痛症状预测胰腺癌胰外神经侵犯与CT判断结果的差异。结果:CT判断77例(59.2%)患者有胰外神经侵犯,其中胰头癌38例(50.7%,38/75),胰体尾癌39例(70.9%,39/55),后者比例明显高于前者(χ~2=78.999,P=0.000);87.0%的可见腹腔干周围神经丛受侵表现,高于左侧腹腔神经节(57.1%)和右侧腹腔神经节受侵率(45.5%)(χ~2=30.415,P=0.000)。48例腰背痛患者中,有47例(97.9%)CT判断有胰外神经侵犯。与CT判断结果比较,本组中腰背痛预测胰腺癌胰外神经侵犯的灵敏度为61.0%,特异性为98.1%,阳性预测值97.9%。一致性检验结果显示,两者有中等一致性(κ=0.545,P=0.000)。结论:腰背痛症状与胰腺癌胰外神经侵犯有关,腰背痛症状和CT影像学特征性改变对于术前预测胰腺癌胰外神经侵犯有互补作用。
Objective: To investigate the predictive value of low back pain in the diagnosis of pancreatic cancer outside the pancreas. Methods: The clinical and imaging data of 130 patients with pancreatic cancer were retrospectively analyzed. All patients with or without external pancreatic nerve invasion by CT to analyze the low back pain symptoms to predict pancreatic cancer pancreatic nerve invasion and CT findings. Results: 77 (59.2%) patients had extra-pancreatic nerve invasion. Among them, 38 (50.7%, 38/75) had pancreatic head cancer and 39 (70.9%, 39/55) had pancreatic body tail cancer. The latter ratio Was significantly higher than the former (χ ~ 2 = 78.999, P = 0.000); 87.0% of the visible peritoneal cavity plexus invasion, higher than the left celiac ganglia (57.1%) and the right celiac ganglia invasion rate 45.5%) (χ ~ 2 = 30.415, P = 0.000). Of the 48 patients with low back pain, 47 (97.9%) had extra-pancreatic nerve involvement on CT. Compared with the results of CT, the sensitivity and specificity of low back pain in predicting pancreatic pancreatic cancer invasion were 61.0%, 98.1% and 97.9% respectively. Consensus tests showed a moderate agreement between the two (κ = 0.545, P = 0.000). CONCLUSION: The symptoms of low back pain are related to the invasion of pancreatic carcinoma of the pancreas. The characteristics of low back pain and CT imaging are complementary to the preoperative prediction of pancreatic cancer outside the pancreas.