64排CT胆道和血管三维重建用于肝门部胆管癌术前评估的研究

64-slice spiral CT 3-D angiography(CTA) and 3-D positive contrast CT cholangiography in the preoperative evaluation of patients with hilar cholangiocarcinoma

目的研究64排CT胆道和血管三维重建（CTA）在肝门部胆管癌术前评估中的应用价值和优缺点。方法对2006年3月至2006年12月8例肝门部胆管癌病人进行增强CT扫描并进行肝动脉、门静脉三维重建，判断肝动脉和门静脉侵犯情况。通过PTBD胆道内注入6．9％泛影葡胺，进行CT平扫和阳性法胆道三维重建，判断肝内胆管的侵犯情况。利用上述结果进行Bismuth—Corlette分型和T分期。术前评估结果与手术探查结果进行对比。结果8例病人均可成功进行CT重建肝动脉，门静脉的三维重建。2例肝动脉系统侵犯病人CTA结果与手术探查一致，5例门静脉系统侵犯病人，3例一致。6例病人肝内胆管1—4级分支在胆道三雏重建时能完全显影。2例病人部分显影。7例病人的Bismuth—Corlette分型和6例T分期术前评估结果与手术探查一致。结论64排CT下胆道和血管三维重建，可作为肝门部胆管癌术前评估的常规方法，其应用价值值得进一步的研究和分析。

Objective To study the value of 64-slice spiral CT 3-D angiography （CTA） and 3-D positive contrast CT cholangiography in preoperative evaluation of patients with hilar cholangiocarcinoma. Methods Contrast enhanced abdominal scanning was performed using 64-slice spiral CT. Hepatic artery and portal vein CTA were performed in 8 cases with hilar cholangiocarcinoma. Plain abdominal scanning was performed after 6. 9% meglumine diatrizoate was injected into bile duct through PTBD. Positive contrast CT cholangiography was performed for these patients. The level and range of hepatic artery, portal vein and bile duct invasion and preoperative Bismuth-Corlette classification and T-Staging were recorded and compared with surgical exploration. Results Successfully hepatic artery, portal vein and bile duct reconstruc- tion were performed for all these patients and complete intrahepatic bile duct cholangiography including 1st to 4th order of bile duct in 6 patients. In the other 2 patients, partial negative intrahepatic bile duct cholangiography were recorded due to 2nd to 3rd order of bile duct incomplete contrast filling. In Bismuth-Corlette classification and T-Staging system,7 patients and 6 patients were respectively in accordance with surgical exploration. Conclusion 64-slice spiral CT 3-D angiography （CTA） and 3-D positive contrast CT cholangiography were effective in assessing tumor blood vessel and bile duct invasion in patients with hilar cholangiocarcinoma. Its usefulness in the guidance of clinical therapy deserves further investigation.