胆管细胞癌超声分型与彩色多普勒血流特征的探讨

Ultrasonic classification and characteristics of color Doppler flow imaging in cholangiocarcinoma

目的探讨胆管细胞癌(CCC)的超声表现及彩色多普勒血流特征。方法对169例胆管细胞癌行二维超声检查,其中76例同时行彩色多普勒超声检查。观察和记录肿瘤所在部位、边界、大小、内部回声、肝内扩张胆管内径、肿瘤周边和内部彩色多普勒血流的分布情况,并根据二维声像表现对胆管细胞癌进行超声分型。结果169例胆管细胞癌超声检出团块型108例,结节型20例,狭窄型13例,囊状型9例,栓塞型12例,复合型(兼有2种或2种以上声像表现)7例。诊断准确率达93.49%(158/169),误诊的11例中5例诊断为单纯肝内胆管结石,4例诊断为单纯肝脓疡,2例诊断为肝内胆管囊状扩张。169例中肝门型胆管细胞癌发生率最高为52.07%(88/169),其次为左肝33.14%(56/169)。肿瘤近端肝内胆管扩张159例(159/169,94.08%)。胆管细胞癌合并结石59例(59/169,34.91%),其声像表现为肿瘤内见强回声团聚集,后伴明显声影,胆管壁显像不清。胆管细胞癌合并肝脓疡14例(14/169,8.28%),其声像表现为肿块内部或肿块旁见低回声液性区,液性区旁扩张的胆管内见实体回声。76例行彩色多普勒超声检查,肿瘤内见丰富动静脉血流信号者仅占14.47%(11/76)。49例(49/76,64.47%)肿瘤包绕门静脉分支致血管内彩色多普勒血流信号消失或血流束变细,其中22例(22/49,44.90%)可见与门静脉并行的肝动脉彩色多普勒血流束,27例(27/49,55.10%)肿瘤内门静脉与肝动脉彩色多普勒血流信号均消失。结论肿瘤形态不规则,境界不清楚,内部回声多样,肿瘤梗阻近端胆管扩张,肿瘤内部门静脉分支彩色多普勒血流信号消失是胆管细胞癌的特征性声像改变。充分认识胆管细胞癌的声像图特征可提高其术前超声诊断率,为临床治疗提供诊断依据。

Objective To investigate the characteristics of ultrasonography and color Doppler flow imaging （CDFI） in cholangiocarcinoma （CCC）. Methods One hundred sixty-nine patients with cholangio- carcinoma were examined by 2-D ultrasound. Among them 76 cases（44.97% ）were also examined on color Doppler ultrasonography. The sites, borders, sizes, the inner echoes of the tumors, the diameters of the intrahepatic dilated bile ducts and the distribution pattern of color Doppler flow signals in peripheral and inside the tumors were observed and recorded. The ultrasonic types of CCC were classified according to the appearances on 2-D ultrasound. Results The ultrasonic images of 169 CCC were classified into clump type（ 108 cases）, nodular type （20）, stenosis type （13）, cystic type （9） , embolism type （12） and complex type （7）. Two or more than two types were included in 7 cases. The ultrasonic diagnostic accuracy rate was 93.49% （158/169）. Among the 11 misdiagnostic patients 5 cases were only diagnosed as intrahepatic biliary duct cholelithiasis, 4 were diagnosed hepatic abscesses, and 2 were considered intrahepatic bile duct cystic dilatation. Eighty-eight（88/169, 52.07% ）CCC cases at porta hepatis were the majority of the study group. The next one was those in the left livers（56/169, 33.14% ）. The intrahepatic bile ducts proximal to the tumors in 159 （94.08%） cases were dilated, 59 cases（59/169, 34.91% ）of CCC were complicated with cholelithiasis. In images of CCC with cholelithiasis, a heap of hyperechoic calculi was inside the tumors with obvious echo shadowing, and the bile duct walls became indefinable. CCC complicated with hepatic abscesses were in 14 cases （ 14/169, 8.28% ）, demonstrating hypoechoic liquid areas inside or nearby tile tumors. The solid echoes could be seen in the dilated bile ducts nearby the liquid areas. Only 11 cases （11/76, 14.47% ） showed abundant arterial and venous CDFI signals in the tumors. The branches of the portal veins （PV） were wrapped up by the tumors in 49 cases （49/76, 64.47% ）and result in the disappearance of CDFI signals or presence of thinner color Doppler flow beams in those branches, of which 22 cases （22/49, 44.90% ） showed the blood flow beams of the hepatic arterial branches （HA） parallel to the PV; 27 cases （27/49, 55. 10% ） showed the blood signals disappeared in both the portal veins and the hepatic arteries in the tumors. Conclusions The sonographic characteristics of CCC are the shapes of the tumors, unclear boundaries defined, inner echoes variable, the dilated bile ducts proximal to obstructed positions lated and adsence of CDFI signals of the portal vein branches. To fully recognize the sonographic characteristics of CCC may improve the ultrasonic diagnostic rate before operation and provide the diagnostic evidence for the clinic.