Vater氏壶腹癌的CT诊断

CT Diagnosis of Carcinoma of Vater’s Ampulla

目的 :探讨Vater氏壶腹癌的CT诊断价值。方法 :对我院经手术病理证实、CT资料完整的 30例Vater氏壶腹癌进行回顾性分析。其中 2 7例行Whipple手术 ,3例行姑息术作内或外引流。检查前 30min、5min分别口服 1%～ 2 %有机碘造影剂 5 0 0ml。常规上腹部CT平扫 +增强扫描 ,梗阻段、兴趣区作 2mm或 5mm薄层扫描。结果 :壶腹部软组织肿块 ,十二指肠腔内充盈缺损及局部肠粘膜破坏 ,壶腹段胆总管壁不规则增厚、偏心性软组织肿块和肝内、外胆管中、高度扩张 ,胆总管全段扩张 ,胆囊增大 ,双管征是Vater氏壶腹癌的直接和间接CT征象。结论 :CT能清晰显示壶腹癌的直接和间接征象。直接征象的显示与检查方法、扫描技术、CT设备有关 ,CT是诊断壶腹癌有效、准确的检查方法。

Objective:This is to study the value of CT diagnosis to carcinoma of Vater’s ampulla.Materials and Methods:Thirty cases of carcinoma of Vater’s ampulla with intact CT data,proved surgically and pathologically,were analyzed retrospectively.Twenty seven of them had Whipplye’s operation done,and 3 were treated palliatively with internal or external drainage.Altogether 500 ml of 1-2% of iodinated contrast media were taken orally 30 minutes and 5 minutes respectively before CT study.Routinely,upper abdomen non-contrast and contrast CT scans were done with 2-5mm thin sections only at the site of obstructed area or ROI.Results:Soft tissue mass of Vater's ampulla,filling defect of duodenal lumen with destruction of mucosal folds,irregular thickening or eccentric mass of ampullary segment of CBD wall and double duct dilatation sign(moderate to severe dilatation of intrahepatic and extrahepatic bile ducts,dilatation of the whole segment of CBD,enlargement of gallbladder and dilatation of pancreatis duct)were found to be the direct and indirect signs of carcinoma of Vater's ampulla.Conclusion:The direct and indirect signs of carcinoma of Vater's ampulla could be fully depicted with CT studies,whereas depiction of CT direct signs was closely related to the methods of examination,scanning technique and especially to the performance of different CT units.Nevertheless,it has been proved that CT study is efficacious and accurate in the diagnosis of carcinoma of Vater's ampulla.