MSCT对肝门区胆管癌的诊断与可切除性评价

Multi-slice CT in the diagnosis and preoperative resectability evaluation of hilar cholangiocarcinoma

目的:探讨MSCT对肝门区胆管癌的诊断及手术可切除性的评估。方法:对MSCT连续性诊断为肝门区胆管癌的62例住院患者进行研究。62例患者分别依次行MSCT平扫、增强扫描及三维重组,所有图像均采用Bismuth-Corlette分型法判断病变类型和美国癌症联合委员会2002年TNM分期判断病变分期。62例均经手术病理(54例)或内镜逆行胰胆管造影(ERCP,8例)证实。结果:62例全部为肝门胆管癌,6例MSCT术前评估不可切除与术中评估一致,56例术前MSCT评估手术可切除中有2例术中评估为不可切除,MSCT诊断可切除组与术中诊断可切除组差异无统计学意义(P>0.05)。CT三维重组较平扫、增强扫描更能提高早期诊断的符合率(P<0.05)。结论:MSCT对肝门胆管癌的早期诊断符合率高,对评价手术可切除性具有重要价值。

Objective：To assess the value of multi-slice CT （MSCT） in the diagnosis and resectability judgement of hilar cholangiocarcinoma.Methods：Prospective MSCT studies for the diagnosis and resectability evaluation of hilar cholangiocarcinoma in 62 consecutive patients were performed.Precontrast and dynamic contrast enhanced （25s and 60s after contrast administration） scans,and reconstructed 3D images were acquired.The CT findings were studied according to Bismuth-Corlette classification and TNM staging classification （AJCC,2002）.All of the 62 cases were proved by surgery and pathology （54 cases） and ERCP （8 cases）.Results：All of the 62 patients had hilar cholangiocarcinoma,6 cases which were evaluated as non-resectable by MSCT were in accordance with surgical findings.In the rest 56 patients which were judged as resectable by MSCT,2 patients were non-resectable,there was no significant statistical difference between MSCT and surgery （P0.05）.Improvement of diagnostic accuracy for early hilar cholangiocarcinoma could be achieved by 3D image reconstruction in addition to plain and contrast enhanced CT （P0.05）.Conclusion：MSCT is helpful in the diagnosis of early hilar cholangiocarcinoma with high accuracy and is important in predicting surgery resectability.