原发性胆囊癌的CT诊断

Diagnostic value of CT on primary carcinoma of gallbladder

目的探讨原发性胆囊癌的CT诊断和鉴别诊断要点,分析原发性胆囊癌的分型及CT表现,以提高早期诊断水平。方法回顾性分析经手术病理证实的25例原发性胆囊癌,总结其术前CT平扫及增强扫描的影像表现,讨论胆囊癌的CT分型、病理学分型。结果根据肿瘤的形态及CT表现将胆囊癌分为三型:①肿块型:13例,占52%;②结节型:8例,占32%;③浸润型:4例,占16%。手术病理腺癌21例、鳞癌4例。9例合并慢性胆囊炎;11例合并胆囊结石;肝脏直接受侵犯16例;侵及胰腺和十二指肠7例;肝脏及淋巴结转移8例;肝内、外胆管扩张13例。结论CT对软组织的分辨率高,可清楚显示胆囊癌的病变部位及程度,为肿瘤分期及能否手术根治提供了准确的依据。胆囊癌的三个类型是胆囊癌病变发展不同阶段的特征性表现,结节型及浸润型是胆囊癌的早期表现,肿块型为胆囊癌的中晚期表现并已直接侵犯肝脏及淋巴结转移,侵犯周围组织等。原发性胆囊癌的早期诊断,应注重胆囊形态的改变、胆囊壁厚度的改变,可行多体位CT扫描,并且重视患者的病史。

Objective To investigate both the diagnostic value and differential diagnosis of CT on primary carcinoma of gallbladder, analyze its clinical typings and CT expression in order to improve the early diagnosis. Method Totally 25 primary carcinoma of gallbladder cases, who were confirmed by surgical pathology examination, were analyzed retrospectively so as to investigate the their post operative CT expressions and clinical typings. Result All the cases were divided into 3 types according to different shapes of tumor and their CT expressions： type of lump in 13 cases （52%）; type of tubercle in 8 cases （32%）; type of infiltration in 4 cases （16%）. There were 21 cases of adenocareinoma and 4 cases of squamous carcinoma respectively. Complications were found in 9 cases with chronic cholecystitis, 11 cases with cholelithiasis cholecystolithiasis, 16 cases with direct violation of liver, 7 cases with direct violation of pancreas and duodenum, 8 cases with liver and lymphatic metastasis, 13 cases with cholangiectasis. Conclusion CT has high resolving power to show the pathological position of gallbladder carcinoma. It provides accurate foundation for typing of the tumor and selection of operation. Three types of gallbladder carcinoma reflect different stages of developing of tumor. Types of lump and infiltration are early stage expression for this tumor, while type of tubercle is expression of middle or late stages in which liver or other tissues could have been violated. In the early diagnosis, change of the pathological shape and the thickness of the wall of gallbladder should be emphasized. Multiple postures could be handled and disease history shoul be emphasized as well.