多层螺旋CT对肝外梗阻性黄疸的诊断评价

Diagnostic value of multi-slice spiral CT in extrahepatic obstructive jaundice

目的:评价多层螺旋CT对肝外梗阻性黄疸的诊断和鉴别诊断价值。方法:回顾分析2009年～2010年间经手术和临床证实的肝外梗阻性黄疸68例,将所有病例按良恶性分成两组,良性组36例,恶性组32例。其中20例同时再行增强扫描,图像后处理采用MIP、MPR、CPR等。观察CT定量及定性指标:胆总管内径,肝内胆管扩张程度,梗阻部位距肝门部长度;有无结石,有无肿块及肿块部位、肿块与胆总管关系、肿块强化程度。结果:所有病例均清晰显示梗阻部位,梗阻部位距肝门长度良恶性组间差别显著(P<0.01);而恶性组中胆管癌和胰头癌分别与壶腹癌之间也有统计学差异(P<0.05)。而胆总管内径各组间差别无显著性(P>0.05)。结论:多层螺旋CT检查对肝外梗阻性黄疸的部位、病因及良恶性的区分准确性较高,对肝外梗阻性黄疸的诊断与鉴别诊断有很大价值。

Objective： To evaluate the diagnostic value and differential diagnostic value of Multislice Spiral CT examination for extrahepatic obstructive jaundice. Methods68 cases of extrahepatic obstructive jaundice proven by the surgery and clinic were collected during a 2-year period from 2009 to 2010. All patients were divided into two groups according to benign or malignant. Benign group were 36 cases, malignant group were 32 cases. Among these, 20 cases were subjected to enhanced scanning in the same time. Images postprocessing included MIP, MPR and CPR. Quantitative and quanlitative indicators included diameter of common bile duct, intrahepatic bile duct dilation degree, obstruction hepatic portal site from the Minister of degrees; with or without stones, availability of mass and dications, relations of mass and common bile duct, and enhance degree of mass. Results： All patients were showed clearly. There were significant differences between benign and malignant groups in the distance from obstruction site to hila （ P %0.01）. And in malignant group, there were significant differences in bile duct cancer, pancreatic cancer and ampullary cancer （ P %0.05）. Diameter of common bile duct in each group had no significant difference （ P 〉0.05）. Conclusion： The accuracy of multi-slice spiral CT examining for extrahepatic obstructive jaundice locality, etiology and the distinction between benign and malignant is quite high and there is great value in diagnosis and differential diagnosis of extrahepatic obstructive jaundice.