Revolution CT多模式重建对肝门部胆管癌术前分期及手术方式评估的研究

Evaluation of preoperative staging and surgical methods of hilar cholangiocarcinoma by Revolution CT multi⁃modal reconstruction

目的探究Revolution CT多模式重建对肝门部胆管癌(HCCA)术前分期及手术方式的评估价值。方法选取鄂尔多斯市中心医院89例HCCA患者,术前均行Revolution CT多模式重建,以手术病理诊断结果为金标准,分析Revolution CT多模式重建诊断HCCA肿瘤类型、肝叶萎缩、肝动脉侵犯、门静脉侵犯、淋巴结转移、Bismuth-Corlette分型、临床分期及手术可切除性的价值。结果Revolution CT多模式重建诊断的HCCA肿瘤类型与手术病理诊断结果一致,诊断准确率为100%。Revolution CT多模式重建诊断HCCA肝叶萎缩、肝动脉侵犯、门静脉侵犯、淋巴结转移结果与手术病理诊断结果比较,差异无统计学意义(P>0.05)。Revolution CT多模式重建诊断HCCA Bismuth-Corlette分型与手术病理诊断的Kappa值为0.886(95%CI:0.781~0.992),诊断符合率为91.01%(P<0.05)。Revolution CT多模式重建诊断HCCA临床分期与手术病理诊断的Kappa值为0.891(95%CI:0.766~1.016),诊断符合率为92.13%(P<0.05)。Revolution CT多模式重建诊断HCCA手术可切除性与手术病理诊断的Kappa值为0.887(95%CI:0.681~1.094),诊断符合率为94.38%(P<0.05)。结论Revolution CT多模式重建能准确判断术前HCCA肿瘤类型、Bismuth-Corlette分型和临床分期,可为临床制定个性化手术方案提供可靠依据。

Objective To explore the evaluation value of preoperative staging and surgical methods of hilar cholangiocarcinoma(HCCA)by Revolution CT multimodal reconstruction.Methods A total of 89 patients with HCCA in Erdos Central Hospital were selected and all of them underwent Revolution CT multimodal reconstruction before surgery.The value of Revolution CT multimodal reconstruction in diagnosing HCCA tumor type,liver lobe atrophy,hepatic artery invasion,portal vein invasion,lymph node metastasis,Bismuth-Corlette classification,clinical staging and surgical resectability was analyzed by taking the surgical pathological diagnosis results as the gold standard.Results The HCCA tumor type diagnosed by Revolution CT multimodal reconstruction was consistent with the results of surgical pathological diagnosis,with the diagnostic accuracy rate of 100%.There was no significant difference between the results of Revolution CT multimodal reconstruction in the diagnosis of hepatic lobe atrophy,hepatic artery invasion,portal vein invasion or lymph node metastasis of HCCA compared with surgical pathological diagnosis(P>0.05).The Kappa value between Revolution CT multimodal reconstruction and surgical pathological diagnosis in the diagnosis of HCCA Bismuth-Corlette classification was 0.886(95%CI:0.781 to 0.992),and the diagnostic coincidence rate was 91.01%(P<0.05).The Kappa value of Revolution CT multimodal reconstruction and surgical pathological diagnosis in the diagnosis of HCCA clinical staging was 0.891(95%CI:0.766 to 1.016),with the diagnostic coincidence rate of 92.13%(P<0.05).The Kappa value of Revolution CT multimodal reconstruction and surgical pathological diagnosis in the diagnosis of HCCA surgical resectability was 0.887(95%CI:0.681 to 1.094),with the diagnostic coincidence rate of 94.38%(P<0.05).Conclusion Revolution CT multimodal reconstruction can accurately determine the preoperative tumor type,Bismuth-Corlette classification and clinical staging of HCCA,which can provide a reliable reference for the development of personalized surgical plans in clinic.