肝外胆管癌影像学诊断的价值

The Value of Radiographic Imaging In The Diagnosis of Extrahepatic Cholangiocarcinoma

报告５５例肝外胆管癌的影像学检查结果，对其特征进行了分析．病变位于肝外胆管上、中、下段者各为２４例（４３．６４％）；１２例（２１．８２％）；１９例（３４．５４％）．其中４１例病理诊断为浸润型（２４例）、结节型（６例）、乳头型（１１例）．直接胆道造影显示有狭窄型、阻塞型和息肉型．ＰＴＣ、ＥＲＣＰ、ＣＴ、Ｂ超的诊断准确率分别为９３．３３％，７１．４３％，６６．６７％；５８．１８％．以ＰＴＣ检查的准确率最高．黄疸病人应首选Ｂ超检查，以了解胆管有无扩张，一旦发现胆管扩张，应作ＰＴＣ查，并酌情选用ＥＲＣＰ、ＣＴ或选择性血管造影．

The radiographic imaging features and their role in the diagnosis of a total of 55patients with extrahepatic cholangiocarcinoma were evaluated.The lesions were found at upper part of the extrahepatic bile duct in 24(43. 64%) cases, at middle part in 12(21.82%)and at lower part in 19(34.54%),respectively.Out of 41 cases,4 were proved by pathological study to be of infiltrative, 6 of nodular aam 11 of papillary type.Constricted(24/41),obstructed(6/41)and polyp(11/41),were demonstrated by direct cholangiograpby.The diagnostic accuracy of percutaneous transhepatic cholangiography(PTC),B ultrasonographs(US),endoscopic retrograde cholangiopancreatography(ERCP)and computed tomography(CT)were 93.33%,58.18%,71.43% and 66.6.7%,respectively.Of them,PTC was the most accurate one(P<0.05).We proposed that US should be the first screening procedure in patients with suspected jaundice to determine whether there is a dilatation of bile duct. PTC,ERCP and CTshould be performed too,if necessary.