十二指肠乳头恶性肿瘤的CT诊断

CT Diagnosis of Carcinoma of Duodenal Papilla

目的讨论十二指肠乳头恶性肿瘤的CT表现及其诊断价值。方法回顾研究十二指肠乳头恶性肿瘤11例,9例手术病理证实,2例CT表现典型并有腹膜后淋巴结转移,分析其CT直接征象(十二指降段内侧乳头区不规则软组织肿块及其毗邻关系)及间接征象(肝内外胆管扩张),并与37例低位良性梗阻病例进行对比分析。结果11例显示明显直接征象的有6例,其中4例与手术结果大致一致,可疑的有2例,阴性的3例;11例全部显示间接征象,肝内外胆管中—重度扩张(胆总管平均值为2.1±0.5cm),其扩张程度与低位良性梗阻在统计学上有差异(t=8.984,P<0.01)。结论CT是诊断十二指肠乳头恶性肿瘤的有效而准确的方法,是手术可切除性评价的有效方法。但在早期CT难于诊断,若不明原因的中—重度无痛性低位梗阻性黄疸患者,应怀疑本病。

Objective To discuss of duodenal papilla carcinoma.Methods Retrospective study of duodenal papilla carcinoma in 11 cases,,nine cases confirmed by operation and pathology,two cases of the performance of a typical CT and a retroperitoneal lymph node metastasis,analyzed CT direct sign（Descending duodenum papilla medial segment irregular soft tissue mass） and indirect signs（liver bile ducts inside and outside the expansion）,9 cases with surgical case-control analysis of 37 cases with low comparative analysis of cases of benign obstruction.Results 6 cases（6/11） shows a clear direct sign,of which 4 cases are generally consistent,there were two cases of suspected,negative in 4 cases;11 cases all showed indirect signs of extrahepatic bile duct-moderate to severe dilation（average of common bile duct value of 2.1 ± 0.5cm）,comparing with the low level of benign obstruction had significant difference（t=8.984,P0.01）.Conclusion CT diagnosis of duodenal papilla carcinoma,is effective and accurate method for surgical resectability evaluation methods,but difficult in early stage diagnosis,Considered unexplained painless obstructive jaundice accompanied by moderate to severe bile duct dilation,duodenal papilla carcinoma should be suspected.