胆管结石取出后胆管癌及胆管癌合并胆管结石的MR影像及临床分析

Analysis of MR imaging and clinical features in cholangiocarcinoma and cholangiocarcinoma with choledocholithiasis after removal of choledocholithiasis

目的探讨胆管结石取出后发生胆管癌及胆管癌合并胆管结石的MR影像及临床特点。方法回顾性分析胆管结石取出术后再发胆管癌37例,分为胆管癌合并胆管结石组(7例)及胆管癌组(30例),分析其MR影像表现及临床特征,并与病理结果进行比较。结果胆管癌合并胆管结石组中黏膜下癌占85.7%,高于单纯胆管癌组,差异有统计学意义(P<0.05),MR增强扫描及MRCP对胆管癌的诊断与病理结果符合率高(35/37),同时MRCP测量胆管癌合并胆管结石的胆管直径小于单纯胆管癌,差异有统计学意义(P<0.05);临床病史中腹痛及胆囊切除病史两组差异有统计学意义P<0.05)。结论胆管结石是胆管癌发生的危险因素之一,在经胆管取石术后,MR增强扫描与MRCP诊断胆管癌的准确率高,可以对合并胆管结石的胆管癌患者做出早期诊断,有利于患者的治疗及预后。

Objective To discuss the clinical characters and the magnetic resonance （MR） imaging in cholangiocarcinoma and cholangiocareinoma with choledocholithiasis after removal of choledocholithiasis. Methods Thirty-seven cases of cholangiocarcino- ma after the removal of choledocholithiasis were retrospective analyzed. We assigned the 7 patients of cholangiocarcinoma with cho- ledocholithiasis into Group A and the 30 patients with cholangiocarcinoma into Group B. Results Suhmucosal cancer accounted for 85.7% in Group A, significantly higher than that in Group B （P 〈 0.05）. The coincidence rate of MR enhanced scanning with magnetic resonance cholangiopaneretography （MRCP） and pathological findings was high （35/37）. Measured by MRCP, the duct diameter of Group A was significantly smaller than that of Group B （P 〈 0.05 ）. As for disease history, there were significant differences in abdominal pain and cholecystectomy between the two groups （ P 〈 0.05 ）. Conclusion Choledocholithiasis is one of the risk factors for the occurrence of cholangiocarcinoma. The diagnostic accuracy of MR enhanced scanning with MRCP is high, which helps to make early diagnosis of cholangiocarcinoma with choledocholithiasis and benefits the treatment and prognosis for the patients after removal of choledocholithiasis.