螺旋CT在原发性胆囊癌诊断中的价值和误诊分析

Value of spiral CT in the diagnosis of primary gallbladder cancer and misdiagnosis analysis

目的:通过分析不同类型原发性胆囊癌的CT表现,以提高诊断和鉴别诊断能力;探讨螺旋CT对原发性胆囊癌的诊断价值以及指导手术的价值,并分析误诊的原因。方法:回顾性分析25例经手术病理证实的原发性胆囊癌CT表现。结果:根据CT表现分为:肿块型12例(48%),结节型8例(32%),壁厚型5例(20%)。常伴有胆囊结石,易发生肝浸润转移及胰头周围淋巴结转移。原发性胆囊癌术前用CT检查正确诊断22例,占88%。结论:原发性胆囊癌的CT检查直接征象有肿块型、腔内结节型和壁厚型。掌握原发性胆囊癌的特征性CT表现,有助于提高诊断与鉴别诊断的准确性。误诊的主要原因是癌变的肝硬化结节侵及胆囊。

Objective To discuss the diagnosis value and guiding value of CT for surgical operation of gallbladder carcinoma,and analyze the misdiagnosis reasons,in order to improve the diagnosis and differential diagnosis level of primary gallbladder cancer.Method The CT materials of 25 cases（male 9 cases,female 16 cases）with pathological diagnosis of primary gallbladder carcinoma after operation were analyzed.Most of the cases were 65~73 years old.All of the cases were both received regular and intensive scan with Toshiba Asteion four array CT machine made in Japan.Results The CT appearances of gallbladder carcinoma were divided as a huge mass pattern in 12 cases（48%）,a nodular pattern in 8 cases（32%）and thicken wall pattern in 5 cases（20%）.The tumor mass pattern appeared as a tumor mass in gallbladder,being differed from the liver cancer.The nodular pattern appeared as some lobular soft tissue nodes in gallbladder.The wall thicken pattern appeared as irregular,non-symmetric thicken wall of gallbladder,being differed from even thicken wall.Gallbladder cancer usually companied with gallstone and metastasis to lymphatic nodes around the liver and the pancreas.Conclusion ①22 cases of the primary gallbladder cancer are diagnosed correctly before the surgical operation,and the correct diagnosis rate is 88%.②The direct signs of the CT examination of the primary gallbladder carcinoma are divided as the massive pattern,the nodular pattern and the wall thicken pattern.The characteristic CT signs of primary gallbladder carcinoma might be useful for improving the diagnosis accuracy and the distinguishing diagnosis.③The cirrhosis nodular becoming cancer has invaded gallbladder is principal element of making a wrong diagnosis.