CT三维重建在肝门部胆管癌诊疗中的价值

Three-dimensional reconstruction of CT in diagnosis and treatment of hilar cholangiocarcinoma

目的探讨CT三维重建在肝门部胆管癌诊疗中的价值。方法选取从2013年8月到2014年9月安徽医科大学第一附属医院收治肝门部胆管癌病人10例,每例病人均收集详细临床资料,根据其术前CT、MRI+MRCP以及CT三维重建结果分别行Bismuth-Corlette分型,比较其差异性,按照术前分型不同,分别拟定手术方案。肿瘤分型以实际手术中探查为准,手术方式与术前拟定方式相比较。所有患者均取肿瘤及周围肿大淋巴结作病理检测,与术前判断结果比较。结果术前CT判断的符合率为7/10,MRI+MRCP为7/10,CT三维重建为9/10,三维重建判断肿瘤分型准确率更高,三种方法联合诊断价值更高。手术结果为左半肝切除术4例,局部切除2例,姑息性切除2例,剖腹探查肝内胆管引流2例,与术前符合为9/10术前经CT三维重建发现肿大淋巴结者3例,其手术后病例均提示肿瘤转移,未发现肿大淋巴结者7例,淋巴结检出转移者2例,术前重建结果发现肿大淋巴结者应高度怀疑转移可能。结论 CT三维重建联合CT、MRI+MRCP在肝门部胆管癌治疗中具有一定临床价值。

Objective Explore the value of CT three dimensiomal reconstruction in the diagnosis and treatment of hilar holangiocarcinoma. Methods From August 2013 to September 2014, the First Affiliated Hospital of Anhui Medical University, admitted 10 cases of patients with hilar cholangiocarcinoma, each patient were collected detailed clinical data, Classify them into different type by their preoperative CT, MRI ＋ MRCP and CT reconstruction results with the Bismuth-Corlette classification criteria , compare their differences. Formulate operation program according to the different preoperative classification, The classification of tumor will be subject to probe in practical operation, the operation method would be compared with the preoperative proposed way. All patients had been taking the tumor and surrounding lymph nodes for pathological examination. Results Preoperative CT judge coincidence was 7/10, MRI ＋ MRCP was 7/10, CT three-dimensional reconstruction was 9/10,The accuracy of tumor type of three-dimensional reconstruc- tion was higher than others, and we could improve the diagnostic value by combined the three different methods. Surgical results of 4 cases of left liver resection, local resection in 2 cases, palliative resection in 2 cases, laparotomy intrahepatic bile duct drainage in 2 cases, With preoperative conform to is 9/10. There were three patients who had found lymph nodes by preoperative CT reconstruction had been confirmed as tumor metastasis by pathologically. Lymph nodes swollen lymph nodes are not found in 7 cases, check out the transfer in 2 cases. The one who had found lymph nodes by the CT reconstruction should be highly suspected the tumor has been transferred. Conclusion The CT three dimensional reconstruction combined with CT, MRI ＋ MRCP has some clinical value in the treatment of hilar cholangiocarcinoma.