胆囊癌侵犯胃肠道的螺旋CT诊断(附8例分析)

Diagnosis of Gastrointestinal Invasion by Carcinoma of Gallbladder on Spiral CT(Report of 8 Cases )

目的 探讨胆囊癌侵犯胃肠道的螺旋CT表现,以提高对本病的认识。方法 回顾性分析我院1998年11月至2004年8月期间8例经手术和病理证实伴有胃肠道侵犯的胆囊癌患者的CT表现。8 例均行CT平扫及增强双期扫描,并于扫描前饮入对比剂使上消化道充盈。结果 8例中有2例胃窦受侵,6 例十二指肠受侵,3 例结肠肝曲受侵。术前CT诊断较为肯定的有2 例胃窦和4 例十二指肠受侵,表现为胆囊与受侵器官之间脂肪间隙不清、受侵处胃肠壁增厚、肿块形成、管腔狭窄等征象; 对3例结肠肝曲受侵CT均不能肯定诊断。结论 CT对判断胆囊癌是否侵犯胃和十二指肠有一定作用,但是对结肠肝曲受侵较难准确诊断。

Objective To study the spiral CT features of gastrointestinal invasion by carcinoma of gallbladder. Methods Eight patients with surgical-pathologically documented gastrointestinal invasion by carcinoma of gallbladder were analyzed retrospectively. All patients underwent plain and contrast-enhanced dual-phase scanning of the abdomen. Oral contrast medium (1.2% Angiografin) was used to fill the gastrointestinal tract before CT scanning. Results There were 2 cases of gastric antrum invasion, 6 duodenal invasion and 3 colonic invasion according to the surgical and pathological findings. Spiral CT correctly diagnosed 2 gastric invasion and 4 duodenal invasion based on several imaging features, like blurring of fat plane, focal wall thickening and luminal narrowing of involved gastrointestinal segments, and mass formation. However CT was unable to diagnose the 3 cases of hepatic flexure of colon invasion. Conclusion CT is valuable for diagnosing upper gastrointestinal tract invasion by carcinoma of gallbladder, yet the diagnosis of hepatic flexure of colon invasion is still difficult.