影像学检查技术在壶腹周围癌诊断上的合理应用

Rational Application of Imaging Techniques in the Diagnosis of Periampullary Carcinomas.

目的 :探讨影像学检查技术在壶腹周围诊断上的合理应用。方法 :对我院 185例壶腹周围癌 (包括胰头癌 119例、十二指肠乳头癌 41例、Vater壶腹癌 13例、胆总管下段癌 12例 )的临床特点和各种影像学检查资料进行回顾性分析。结果 :本组CT诊断胰头癌的准确率为 90 .9% ;ERCP对十二指肠乳头癌的确诊率为 10 0 % ;ERCP和MRCP对壶腹癌和胆总管下段癌的诊断价值优于其他检查。 78%的病人上腹部饱胀 /隐痛出现时间早于黄疸 1～ 3月。血清CA19 9值在 3/ 4以上的胰头癌、壶腹癌和胆总管下段癌病人超过正常值。结论 :凡有中上腹部饱胀、隐痛、血清CA19 9值升高、胆总管和 (或 )胰管扩张的病人应有步骤地进行各种影像学检查。超声检查发现胰头部有肿块 ,宜行CT检查。如未发现肿块 ,则行ERCP。凡ERCP检查时观察到有肿瘤征象的病人 ,不宜作胰胆管造影而仅作活检。MRCP可用于胰胆管造影失败的壶腹癌和胆总管下段癌。

Objective: To explore the rational application of imaging techniques in the diagnosis of periampullary carcinomas. Methods: A retrospective study of 185 cases of periampullary carcinomas was conducted, including carcinomas of the head of pancreas(n=119), carcinomas of the duodenal papilla(n=41), carcinomas of the ampulla of Vater(n=13) and carcinomas of the distal common bile duct(CBD)(n=12).Results: The accuracy of CT to diagnose carcinomas of the head of pancreas was 90.9%. The accuracy of ERCP to diagnose carcinomas of the duodenal papilla was 100%. Compared to other imaging techniques, ERCP and MRI had higher accuracy rate in diagnosing carcinomas of the ampulla of Vater. Of all the patients who presented upper abdominal distension and/or occult pain, 78% had these symptoms 1 to 3 months prior to the appearance of jaundice. Over 3/4 of the patients had CA19-9 serum level higher than the normal. Conclusions: Patients presenting upper abdominal distension, occult pain, elevated CA19-9 serum level or dilatation of the CBD and/or pancreatic duct should be submitted to further investigations. When tumor is observed during ERCP, it was recommend not to perform cholangio-pancreatography, but biopsy only. MRCP could be useful in cases of ampullary or distal CBD carcinomas which cannot be demonstrated by cholangiopancreatography. EUS could play an important role in the diagnosis and diffe-rential diagnosis of periampullary carcinomas.