梗阻性黄疸的CT诊断(附60例分析)

CT diagnosis of the obstructive jaundice:an analysis of 60 cases

目的探讨梗阻性黄疸的CT特征,并提高良恶性梗阻性黄疸术前CT签别诊断准确性。方法60例经手术病理证实的梗阻性黄疸患者术前均经常规腹部CT扫描,其中,45例又经增强扫描。所有患者的CT表现与手术病理进行了对照。结果术前CT诊断胆管结石26例,胰头癌20例,胆管癌10例,壶腹癌3例及肝门部转移癌1例。与手术病理对照,仅1例壶腹癌术前CT误诊为胆总管下端等密度结石。本组CT诊断梗阻性黄疸的敏感性、特异性和准确性分别为97.14%,96.15%和98.33%。结论CT能清晰显示梗阻胆管的改变及导致梗阻的原发病灶及其对周围结构的浸润和转移情况,并为临床治疗提供可靠的影像学依据。

Objective To investigate CT feature of the obstructive jaundice and to elevate the accuracy of CT in differentiating benign-from malignant obstructive jaundice.Methods Sixty patients with surgically and pathologically proved obstructive jaundice underwent conventional CT scans of the abdomen before the operation.Of whom,45 patients underwent additional contrast enhanced CT scans.CT findings in all patients were compared with pathologic findings.Results Among 60 cases,preoperative CT diagnosed 26 choledocholithiases,20 pancreatic head carcinomas,10 eholangiocarciuomas;3 ampullary carcinomas,and 1 metastatic carcinoma in hepatic hilum.Compared with postoperative pathology,only one case of ampullary carcinoma was misdiagnoscd as isodense choledncholithiasis on CT image.The sensitivity, specifietity and accuracy of CT in diagnosing the obstructive jaundice in the group patients were 97.14%,96.15% and 98.33%,respectively. Conclusion CT scanning can clearly show the pathologic changes of the obstructive bile ducts,the primary lesions led up to the obstruction and their infiltrating and metastasiziug into the neighbour structures,so that,it can provide the reliable imaging evidence for guiding clinical treatment.