肝门部胆管癌超声诊断的临床价值

目的 探讨肝门部胆管癌(HCCA)超声诊断的临床价值.方法 将59例肝门部胆管癌病人二维声像表现按团块型、结节型、狭窄型和栓塞型进行超声图像分型;超声显示病变侵犯范围采用Bismuth-Corlette Ⅰ～Ⅳ分型法进行分型;手术方式分为病损切除术与胆道内或外引流术.将声像表现分型与Bismuth-Corlette分型进行比较;观察Bismuth Corlette各型与手术方式的关系;对比不同手术方式与肿瘤最大径的关系.结果 59例HCCA的超声诊断准确率为96.61%(57/59).其中42.37%(25/59)行病损切除术,57.63%(34/59)行胆道内或外引流术.59例中团块型与Bismuth Corlette Ⅳ型所占比例最大,分别达64.41%(38/59)和50.85%(30/59).团块型中以Bismuth-CorletteⅣ型所占比例最大(60.53%,23/38);而结节型均为Bismuth-CorletteⅡ型(100.00%,9/9).Bismuth Corlette Ⅱ型的病损切除率最高,达62.50%(10/16).病损切除术组中肿瘤最大径<4 cm的占68.00%(17/25),而胆肠内或外引流术组中肿瘤最大径>4 cm的占76.47%(26/34),二者比较有统计学意义(P<0.01).结论 超声诊断HCCA具有重要的临床价值,声像表现为结节型、Bismuth-Corlette Ⅱ型及肿瘤最大径<4cm可作为HCCA病损切除的重要指标.

Clinical value of ultrasonography for diagnosis of hilar cholangiocarcinoma

Objective To determine the clinical value of ultrasonography for diagnosis of hilar cholangiocarcinoma (HCCA). Methods The 2-D ultrasonograms of 59 cases of HCCA were classified into clump type, nodule type, stenosis type and embolism type. The infiltrating areas of the tumors showed by ultrasonography were classified according to Bismuth-Corlette Ⅰ-Ⅳ types. The operation patterns were classified into lesion excision and internal or external drainage of biliary tract. The types of the 2-D ultrasonograms were compared with the Bismuth-Corlette types. The relation of the Bis-muth-Corlette type to the operation patterns and that of the operation patterns to the maximum diame-ter of the tumors was explored. Results The accurate rate of the ultrasonic diagnosis of the 59 cases of HCCA was 96. 61% (57/59). Amongst the 59 cases, lesion excision was performed in 25 (42.37%) and internal or external drainage of biliary tract in 34(57.63%). In this group of patients, the clump type as well as the type of Bismuth-Corlette Ⅳ accounted the most proportions of 64.41 (38/59) and 50.85% (30/59) respectively, and the type of Bismuth-Corlette Ⅳ accounted the most proportion (60.53%, 23/38) of the clump type. All the cases of nodule type (100.00%, 9/9) be-longed to Bismuth-Corlette Ⅱ. The ratio (62.50%, 10/16) of lesion excision of Bismuth-Corlette Ⅱ was the highest. The diameters of 68.00% (17/25) of tumors in the lesion excision group were less than 4 cm, yet which of 76.47%(26/34) of tumors in the biliary drainage group were more than 4 cm. There was statistical significance(P<0.01)between the two groups. Conclusion It is of important clinical significance to diagnose HCCA by ultrasonography. The nodule type and Bismuth-Corlette Ⅱas well as less than 4 cm in the diameter of the tumor showed in ultrasonogram might be the important indexes of lesion excision.