medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-2020-1-29-38medvis-859Research ArticleБРЮШНАЯ ПОЛОСТЬABDOMENПанкреатический свищ при проксимальной резекции поджелудочной железы: корреляция компьютерно-томографических и морфологических предикторовPancreatic fistula in proximal pancreas resection: correlation of computed tomography and morphological predictorshttps://orcid.org/0000-0001-9063-4565ГальчинаЮ. С.GalchinaYu. S.

аспирант по специальности «лучевая диагностика и лучевая терапия» 

117997 Москва, ул. Большая Серпуховская, д. 27, Российская Федерация Тел.: +7-926-903-23-57

graduate student in the specialty “radiology diagnostics and radiation therapy” 

27, Bol'shaya Serpukhovskaia str., Moscow, 117997, RussianFederation

Phone: +7-926-903-23-57

 

jgalchina@gmail.comhttps://orcid.org/0000-0002-9357-0998КармазановскийГ. Г.KаrmаzаnovskyG. G.

член-корр. РАН, д.м.н., профессор, заведующий отделением рентгенологии и магнитно-резонансных исследований с кабинетом ультразвуковой диагностики; профессор кафедры лучевой диагностики и терапии медико-биологического факультета 

117997 Москва, ул. Большая Серпуховская, д. 27, Российская Федерация

России; 117997 Москва, ул. Островитянова, д. 1, Российская Федерация

сorresponding member of the Russiаn Асаdemy of Sсienсes, doсt. of med. sсi., Professor, Heаd of X-ray and magnetic resonance studies department with ultrasound; Professor of radiology department

27, Bol'shaya Serpukhovskaia str., Moscow, 117997, RussianFederation

house 1, Ostrivityanova str., Moscow, 117997, Russian Federation

karmazanovsky@yandex.ruhttps://orcid.org/0000-0001-6247-9481КалининД. В.KalininD. V.

кандидат медицинских наук, заведующий патологоанатомическим отделением 

117997 Москва, ул. Большая Серпуховская, д. 27, Российская Федерация 

Ph.D, Heаd of Pathology department 

27, Bol'shaya Serpukhovskaia str., Moscow, 117997, RussianFederation

dmitry.v.kalinin@gmail.comhttps://orcid.org/0000-0001-7070-3391КондратьевЕ. В.KondratyevE. V.

кандидат медицинских наук, старший научный сотрудник отделения рентгенологии и магнитно-резонансных исследований

117997 Москва, ул. Большая Серпуховская, д. 27, Российская Федерация 

Ph.D, senior staff scientist of radiology department 

27, Bol'shaya Serpukhovskaia str., Moscow, 117997, RussianFederation

evgenykondratiev@gmail.comhttps://orcid.org/0000-0002-6452-4458ГоринД. С.GorinD. S.

кандидат медицинских наук, старший научный сотрудник отделения абдоминальной хирургии 

117997 Москва, ул. Большая Серпуховская, д. 27, Российская Федерация 

Ph.D., the senior research of Abdominal Surgery Department

27, Bol'shaya Serpukhovskaia str., Moscow, 117997, RussianFederation

Gorin@ixv.ruhttps://orcid.org/0000-0001-7173-4894ГалкинГ. В.GalkinG. V.

аспирант 

117997 Москва, ул. Большая Серпуховская, д. 27, Российская Федерация 

Postgraduate of Abdominal Surgery Department 

27, Bol'shaya Serpukhovskaia str., Moscow, 117997, RussianFederation

iglebgalkin@gmail.comhttps://orcid.org/0000-0002-4567-8312КригерА. Г.KrigerA. G.

д.м.н., профессор, заведующий отделением абдоминальной хирургии 

117997 Москва, ул. Большая Серпуховская, д. 27, Российская Федерация 

Ph.D., Professor, Chair of Abdominal Surgery Department 

27, Bol'shaya Serpukhovskaia str., Moscow, 117997, RussianFederation

kriger@ixv.ruФГБУ «Национальный медицинский исследовательский центр хирургии им. А.В. Вишневского» Минздрава РоссииРоссияA.V. Vishnevsky National Medical Research Center of SurgeryRussian FederationФГБУ «Национальный медицинский исследовательский центр хирургии им. А. В. Вишневского»; ФГБОУ ВО Российский национальный исследовательский медицинский университет им. Н.И. Пирогова Минздрава РоссииРоссияA.V. Vishnevsky National Medical Research Center of Surgery; Professor of radiology department of Pirogov Russian national research medical universityRussian FederationФГБУ «Национальный медицинский исследовательский центр хирургии им. А.В. Вишневского»РоссияA.V. Vishnevsky National Medical Research Center of SurgeryRussian FederationФГБУ «Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского» Минздрава РоссииРоссияA.V. Vishnevsky National Medical Research Center of SurgeryRussian FederationФГБУ «Национальный медицинский исследовательский центр хирургии им. А.В. Вишневского» Минздрава России.РоссияA.V. Vishnevsky National Medical Research Center of SurgeryRussian Federation202029042020241Медицинская визуализация 2020№12938Copyright © Гальчина Ю.С., Кармазановский Г.Г., Калинин Д.В., Кондратьев Е.В., Горин Д.С., Галкин Г.В., Кригер А.Г., 20202020Гальчина Ю.С., Кармазановский Г.Г., Калинин Д.В., Кондратьев Е.В., Горин Д.С., Галкин Г.В., Кригер А.Г.Galchina Y.S., Kаrmаzаnovsky G.G., Kalinin D.V., Kondratyev E.V., Gorin D.S., Galkin G.V., Kriger A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/859Цель исследования

Цель исследования: определить возможности компьютерной томографии с контрастным усилением в оценке степени фиброза и количества ацинарных структур в паренхиме поджелудочной железы для прогнозирования тяжелого течения послеоперационного периода при проксимальных резекциях поджелудочной железы.

Материал и методы

Материал и методы. В отделении абдоминальной хирургии в 2016–2019 гг. было выполнено 196 панкреатодуоденальных резекций. Ретроспективно было отобрано 49 пациентов. Пациенты были разделены на 2 группы в соответствии с течением послеоперационного периода. Послеоперационный период протекал гладко в 41 (84%) случае. Клинически значимый панкреатический свищ развился в 8 (16%) случаях. По данным дооперационной компьютерной томографии (КТ) с контрастным усилением оценивали структуру дистального отдела железы, плотность дистального отдела железы в нативную фазу сканирования (HU), коэффициент накопления контрастного вещества паренхимой (КН), коэффициент накопления контрастного препарата в венозную (КНвен.) и выделительную (КНвыдел.) фазы, коэффициент относительного вымывания контрастного вещества (L/E). Гистологически оценивали количество фиброза, жира и ацинарных клеток в срезе удаленной железы.

Результаты

Результаты. “Мягкая” структура поджелудочной железы (r = 0,747, p = 0,000), значения коэффициента КН (r = 0,631, p = 0,000), плотность дистального отдела железы в нативную фазу сканирования (r = 0,568, p = 0,000) положительно коррелировали с тяжелым течением послеоперационного периода и количеством ацинарных клеток. Значения коэффициента КНвыдел. положительно коррелировали с количеством фиброза (r = 0,562, p = 0,000) в железе и отрицательно с течением послеоперационного периода. Риск развития панкреатического свища в 3 раза выше при значениях КН больше 1, чувствительности 75%, специфичности 73%. Риск развития панкреатического свища в 3 раза выше при значениях КНвыдел. менее 0,45, чувствительности 75%, специфичности 63%.

Заключение

Заключение. КТ с контрастным усилением позволяет оценить структуру паренхимы железы, количество фиброза и ацинарных клеток на дооперационном этапе для выделения группы повышенного риска тяжелого течения послеоперационного периода.

Purpose

Purpose: identification of the possibilities of computer tomography with contrast enhancement in evaluated of the degree of fibrosis and number of acinar structures in the pancreatic parenchyma at the preoperative period to predict the development of postoperative complications.

Material and methods

Material and methods: In the department of abdominal surgery in 2016-2019, 196 pancreatoduodenal resections were performed. Retrospectively selected group of patients (49). Patients were divided into 2 groups according with the postoperative period. The postoperative period was uncomplicated in 41 (84%) cases. Сlinically significant pancreatic fistula was in 8 (16%) cases. According to preoperative computed tomography with contrast enhancement, we evaluated: the structure of the pancreas; the density of the pancreas in the native phase of the scan (HU), parenchyma accumulation coefficient; parenchyma accumulation coefficient in the venous phase; parenchyma accumulation coefficient in the excretory phase; coefficient of relative washout of contrast enhancement of parenchyma. According histological we evaluated the number of fibrosis and acinar, fat cells in the section pancreas.

Results

Results: "Soft" structure of the pancreas (r=0,747, p=0,000), parenchyma accumulation coefficient (r=0,631, p=0,000), the density of the pancreas in the native phase of the scan (r=0,568, p=0,000) positively correlated with complicated postoperative period and the number of acinar cells. Parenchyma accumulation coefficient in the excretory phase (r=0,562, p=0,000) positively correlated with the fibrosis pancreas and in the negatively correlated with the complicated postoperative period. The risk of developing pancreatic fistula is 3 times higher with values parenchyma accumulation coefficient greater than 1, sensitivity 75%, specificity 73%. The risk of developing pancreatic fistula is 3 times higher with values parenchyma accumulation coefficient in the excretory phase less than 0.45, sensitivity 75%, specificity 63%.

Conclusions

Conclusions: computed tomography with contrast enhancement allows the structure pancreas, the number of fibrosis and acinar cell sat the preoperative period to pick out the high-risk patient group to the development of postoperative complications.

компьютерная томография с контрастным усилениемацинусыфиброзпослеоперационные осложненияпанкреатический свищкоэффициент накопления контрастного веществакоэффициент вымывания контрастного веществаcomputed tomography with contrast enhancementacinar cellsfibrosispostoperative complicationspancreatic fistulaparenchyma accumulation coefficientparenchyma accumulation coefficient in the excretory phaseReferencesHashimoto Y., Traverso L.W. Incidence of pancreatic anastomoticfailure and delayed gastric emptying after pancreatoduodenectomyin 507 consecutive patients: use of a web-based calculator toimprove homogeneity of definition. Surgery 2010;147:503–515. https://doi.org/10.1016/j.surg.2009.10.034Hashimoto Y., Traverso L.W. Incidence of pancreatic anastomoticfailure and delayed gastric emptying after pancreatoduodenectomyin 507 consecutive patients: use of a web-based calculator toimprove homogeneity of definition. 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The authors declare that there are no conflicts of interest present.