肝门胆管癌多层螺旋CT诊断及其手术可切除性评估价值研究

Hilar cholangiocarcinoma:diagnosis and assessment of resectability with multi-slice CT

目的分析肝门胆管癌多层螺旋CT(MSCT)征象,评估其手术可切除性。方法回顾性地分析广东省人民医院和广东省茂名农垦医院2004年8月至2009年6月28例经临床、手术病理证实的肝门胆管癌病人的MSCT表现,评价肿瘤Bismuth-Corlette分型,评估其手术可切除性,并与手术病理结果对照分析。结果 MSCT对肿瘤定性诊断符合率为92.8%(26/28);对肿瘤分型准确率为96.4%(27/28);术前判断手术可切除13例中,实际手术可切除10例,阳性预测值为76.9%(10/13);术前判断为不可切除15例,实际不可切除14例,均行内或外引流术,阴性预测值为93.3%(14/15);MSCT预测肝门胆管癌可切除性与否的准确率为85.7%(24/28)。结论 MSCT能较准确诊断肝门胆管癌和评价病灶浸润范围,是肝门胆管癌可切除性的术前重要评价方法。

Objective To summarize the muhi-slice CT（MSCT） features of hilar cholangiocarcinoma, and also try to analyze the value of MSCT in evaluating the feasibility of resection. Methods MSCT features of 28 patients with hilar cholangiocarcinoma confirmed by clinical and pathological examination between August 2004 and June 2009 in the Hospital of Maoming Nongken of Guangdong Province were analyzed retrospectively. Bismuth-Corlette classification of the tumor was performed firstly. Feasibility of resection was then evaluated with MSCT images. The conclusion drawn by radiologists was compared with clinical outeomes finally. Results The accuracy rate of＂ MSCT in diagnosing hilar chnlangiocarcinoma is 92.8% （26/28）. The accuracy rate of MSCT in classifying tumor is 96.4% （27/28）. Thirteen patients were suggested resection by MSCT, however 10 of them can be reseeted during the operation. So positive predictive value of MSCT in evaluating the feasibility of resection is 76.9%（10/13）. Fifteen patients were suggested to abandon resection by MSCT, and 14 of them were confirmed by operation and perfbrmed internal and external drainage. So negative predictive value of MSCT in evaluating the feasibility of resection is 93.3%（14/15）. The total accuracy rate of MSCT in evaluating the feasibility of resection of hilar cholangiocareinoma was 85.7%（24/28）. Conclusion MSCT can demonstrate hilar eholangiocarcinoma and assess the extent of tumor involvement accurately. It is an effective modality in assessment of teasibility of resection of hilar cholangiocarcinoma.