胆囊癌的超声表现

Gallbladder carcinoma:2-D sonographic and color Doppler findings

目的分析胆囊癌的二维声像图和彩色多普勒超声表现.方法经手术病理证实的胆囊癌28例,将其超声表现分三型：Ⅰ型：胆囊壁局灶肿块型;Ⅱ型：胆囊形态完全消失,胆囊窝实性肿物型;Ⅲ型：胆囊壁弥漫增厚型.分析胆囊癌对邻近器官侵犯、肝转移、淋巴结转移的彩色多普勒超声表现.结果超声诊断准确率89.3%.Ⅰ型7例：肝转移2例,腹腔腹膜后淋巴结转移1例;Ⅱ型8例：肝受侵6例,肝转移2例,腹腔淋巴结转移3例;Ⅲ型10例：肝受侵7例,肝转移5例,腹腔淋巴结转移6例,腹膜后淋巴结转移6例.28例胆囊癌血流显示率为28.6%（8/28）,最大流速14.7～28.8 cm/s,RI 0.65～0.83.结论Ⅱ型与Ⅲ型肝受侵率较Ⅰ型高,Ⅲ型肝转移和淋巴结转移率较Ⅰ型和Ⅱ型高,超声扫描不仅能检出原发肿瘤,而且能显示肿瘤的侵犯范围、有无转移,为判断能否手术及合理制订综合治疗方案提供帮助;彩超扫描有血流信号时能增强对胆囊癌的诊断信心,但在没有血流信号时,不能完全除外胆囊癌的诊断.

Objective To analyse 2-D sonographic and color Doppler findings of gallbladder carcinoma. Methods A total of 28 cases of gallbladder carcinoma verified by pathology were enrolled. Sonographic findings were classified as follows： Ⅰ ： a focal polypoid mass, Ⅱ ： a solid mass occupying the entire gallbladder, Ⅲ ： diffuse wall thickening. The invaded organs： the liver and lymph node metastases were recorded. On color Doppler sonography, both the maximum flow velocity and RI （resistance index ） were recoided. Results The sonographic diagnostic accuracy was 89.3% （25/28） ： 7 cases were type Ⅰ , 8 cases were type Ⅱ and 10 cases were type Ⅲ. The cases of liver invasion were 0, 6 and 7 in types Ⅰ,Ⅱ and Ⅲ, respectively; of liver metastases were 2, 2 and 5, respectively ; of celiac lymph node metastases were 1, 3 and 6, respectively and retroperitoneal lymph node metastases were 1,0 and 6, respectively. The positive rate of vaseularity was 28.6% （ 8/28 ）, with maximum flow velocity of 14.7-28.8 m/s and RI being 0.65- 0.83. Conclusions Sonography can not only diagnose gallbladder carcinoma ,but also offer information about involving areas and metastases ,which is helpful to surgical strategy. Presence of blood flow signal increases the diagnostic confidence for gallbladder carcinoma, but absence of blood flow signal can not exclude gallbladder carcinoma.