血清肿瘤标志物、多层螺旋CT及核磁共振在诊断胆管癌中的应用比较

Application of Serum Tumor Markers,Multi-slice Spiral CT and Magnetic Resonance Imaging in the Diagnosis of Bile Duct Carcinoma

目的分析血清肿瘤标志物、多层螺旋CT及核磁共振(MRI)在诊断胆管癌中的应用价值。方法选取我院2014年4月至2016年12月期间收治的70例胆管癌患者(定义为胆管癌组),另选50例同期在我院就诊的胆总管良性病变患者作为对照组,均行血清标志物CA19-9、CA125、CEA检测,并行多层螺旋CT、MRI检查,分析胆管癌和胆管良性病变的影像学征象。结果胆管癌组CA19-9、CEA、CA125水平均显著高于对照组(P<0.01),血清总胆红素(TBIL)水平亦显著高于对照组(P<0.01),胆管癌组血清CA19-9、CEA、CA125水平与TBIL均呈正相关(P<0.01)。胆总管良性病变的CT、MRI显示胆管扩张程度不明显,较少见淋巴结肿大和胆管狭窄或截断等,而胆管癌的CT、MRI显示肿块管壁浸润型、肝门部胆管截断、胆管扩张、肝叶萎缩、门静脉侵犯、淋巴结肿大等特征。血清肿瘤标志物、CT、MRI诊断胆管癌的敏感性、特异性、准确度比较均无统计学意义(P>0.05),但三者联合灵敏度、特异性、准确度可达92.75%、88.24%、90.83%,显著较三者单独检测高(P<0.05)。结论胆管癌血清肿瘤标志物CA19-9、CEA、CA125水平异常升高,CT、MRI影像学特征明显,但三者单独诊断仍有局限,三者联合具有较高的诊断效能,建议临床联合血清肿瘤标志物检测和CT、MRI检查。

Objective To evulatethe application value of serum tumor markers, multi-slice spiral CT and magnetic resonance imaging （MRI） in the diagnosis of bile duct carcinoma （ BDC ）. Methods 70 cases of patients with BDC（ BDC group） treated in our hospital from April 2014 to December 2016were enrolled, while another 50 cases of patients with benign lesions of common bile duct were selected as the control group at the same time. The levels of serum markers（ CA19-9, CA125, CEA）were detected, and multi-slice spiral CT and MRI examination were performed among these patients. The imaging signs of BDC and benign lesions of bile duct were analyzed. Results The levels of CA19-9, CEA, CA125 and serum total bilirubin （TBIL）in BDC group were significantly higher than those in the control group （ P 〈 0. 01 ）, and there was a positive correlation between serum CA19-9, CEA, CA125 levels and TBIL level in BDC group （ P 〈 0.01 ）. CT and MRI of benign lesions of common bile ductshowed that the bile duct dilatation was not obvious, also the lymph node enlargement and bile duct stenosis or truncation were rare while CT and MRI of BDC showed the characteristics of mass tube wall of infiltration type, hilar common bile duct truncation, bile duct dilatation, hepatic lobe atrophy, portal vein invasion and lymph node enlargement. There were no significant differences of the sensitivity, specificity and accuracy amonglevels of serum tumor markers, CT and MRI measures in the diagnosis of BDC （ P 〉 0.05 ） but the sensitivity, specificity and accuracy of combined diagnosis of these three （92.75% ,88.24% ,90.83% ）were higher than those of single diagnoses（ P 〈 0.05 ）. Conclusion The levels of serummarkers of BDC including CA19-9, CEA and CA125 are abnormally high, and the CT and MRI findings are characteristic. The information from any single diagnosis of these three methods is limited, while the diagnostic efficiency of combination of these three is high. In clinical practice, the combined detection of levels of serum tumor markers, CT and MRI is recommended.