乏特氏壶腹癌的影像学诊断

IMAGING DIAGNOSIS OF CARCINOMA OF THE AMPULLA OF VATER

１０例经手术及病理诊断的壶腹癌患者，均在本院行ＣＴ及Ｂ超扫描检查，并有十二指肠低张双对比造影（５例）。Ｂ超扫描示总胆管末端截断６例，远端低及中低回声肿物４例。ＣＴ平扫示十二指肠内缘充盈缺损５例，总胆管远端截断５例，肿物４例。增强扫描见３例有胆管壁及／或局部肿物强化。ＣＴ及Ｂ超均检出局部肿大淋巴结（２５ｍｍ）１例。肿物及胰周大血管轮廓不清，提示不能切除。门静脉及肠系膜动、静脉受压移位或变形，但轮廓清晰者则有切除的可能性。ＣＴ及Ｂ超对检出局部＜１０ｍｍ的淋巴结不敏感，对评估Ｔ、Ｎ分期的帮助不大。

Abstract Ten patients with carcinoma of the ampulla of Vater were reviewed with both ultrasonography(US) , CT scans(n=10) , and hypotonic double contrast duodenum examination(n=5). Tumorwas shown by US as abrupt obstruction of distal common bile duct(n=6), a small mass well-delin-eated within the dilated distal common bile duct (CBD)(n=4). The second part of duodenum wasdepicted clearly in CT scan without enhancement, and a smallfilling defect could be revealed at the in-ner surface in 5 cases, as well as an abrupt obstruction of distal CBD, local mass was shown in 4 cas-es. Enhancement of tumor manifested as local mass and/or ductal wall thickening after iv contrast ad-minstration was shown in 3 cases. One case with local lymph node enlargement(25mm)was revealedby US as well as CT. Non-resectability is implicated by the ill-defined contour of tumor mass and/orportal vein , superior mesenteric artery and vein , but resectability cannot be excluded by displacementand distortion of these vessels with clear delineation. Detectability of lymph node smaller than 10mmand evaluation of T, N staging are limited by imaging examinatio.Local filling defect and irregulari-ty of mucous membrane of duodenum were revealed in 4 cases by hypotonic double contrast examina-tion.