影像学技术对肝门部胆管癌的诊断价值

田雨霖教授肝门部胆管瘤早期临床症状多为纳差、消化不良以及右上腹胀闷不适，由于缺乏特异性，常按一般的胃病对症治疗。因此病人到外科就诊时主要症状为黄疽，临床医生围绕黄疽进行检查，影像学检查是鉴别内科黄殖与外科梗阻性黄疽有效的方法。对于胆道梗阻性病变，它能提供梗阻的部位、范围、程度和周围组织有无转移和病灶以上胆管扩张的情况。影像检查的筛选程序应该是BUS—CT—PTC（PTCD）一ERCP或MRCP一选择性血管造影。B超检查为首选，声像图的特点是：肝内胆管高度扩张，左右肝管或肝总管突然截断，肝门部出现肿瘤形成的强…     

肝门部胆管癌诊断进展

作者通过复习相关文献，综述性介绍肝门部胆管癌诊断进展动态。肝门部胆管癌首先症状为上腹不适、隐疼、腹胀、乏力、明显消瘦及进行性黄疸等。目前的实验室检查对胆管癌早期诊断帮助不大。影像学检查如B超，CT和MRI是无损的诊断方法。可帮助明确病变的部位、大小、浸润范围及有无淋巴结和远处转移。如果有肝内胆管扩张或梗阻性黄疸，B超，CT及ERCP是诊断肝门部胆管癌的首选方法，必要时选用PTC或ERCP对进一步检查则更有价值。目前所有的肿瘤标记物的敏感性和特异性均不高。但肿瘤标记物的研究对肝门部胆管癌的早期诊断带来希望。     

影像学检查对肝门部胆管癌的诊断价值

肝门部胆管癌又称Klatskin肿瘤,是指起源于左、右主肝管和肝总管近端1cm以内的胆管细胞癌,包括肝总管、汇合部胆管、左右肝管的一级分支以及双侧尾叶肝管开口的胆管癌。根据其生长方式分为3种类型：浸润型、外生型和管内型。     

影像学技术对肝门胆管癌的诊断价值

肝门部胆管梗阻可由许多病变引起,如结石、炎症、损伤、畸形、肿瘤、结核、硬化性胆管炎、肝癌累及肝门部胆管、肝癌胆管癌栓、胆囊癌累及肝门部胆管、肝门部转移性淋巴结肿大等。采用各种影像学诊断技术的目的在于:(1)确定是否为肝门胆管癌;(2)确定癌肿累及胆管的范围,毗邻器官受浸润,肝脏和淋巴结转移以及腹腔种植等情况。这样可为肿瘤切除可能性的术前评估和治疗方法的选择提供依据。     

各种影像学技术对肝门部胆管癌的诊断价值

肝门部胆管癌是指发生在胆囊管开口以上直至左、右肝管的癌肿，约占肝外胆管癌的36％～75％。因其解剖位置特殊，早期缺乏典型表现而不易诊断。当临床上出现梗阻性黄疸时，已多属晚期，根治性切除困难，切除率仅为7.4％～50．9%，预启极差，术后5年生存率仅为7％～26％。如何通过各种影像学诊断技术力求尽快确诊，并在术前对病变的范围、淋巴结转移、肝脏、肝内胆管及周围血管受累等情况作出比较精确的评价，从而选择相应的手术方式，     

肝门部胆管癌的影像学诊断及评价

肝门部胆管癌（又称Klatskin瘤）血供较差，对放、化疗不敏感。手术切除仍是最好的治疗方法。早期诊断和对术前可切除性的判断是手术治疗成功与否的的关键。本文就肝门部胆管癌的影像学诊断方面的情况，结合个人的经验加以综合和评价。     

影像学检查在肝门部胆管癌诊断中的应用

肝门部胆管癌又称Klatskin肿瘤,是指起源于左、右主肝管和肝总管近端1cm以内的胆管细胞癌,包括肝总管、汇合部胆管、左右肝管的一级分支以及双侧尾叶肝管的开口的胆管癌。根据其生长方式肝门部胆管癌分为3种类型:浸润型、外生型、管内型[1]。该病近年来发病率呈上升趋势,原发性     

肝门部胆管癌的临床诊断与手术治疗分析

目的探讨肝门部胆管癌的临床诊断方法及两种不同手术方法的预后。方法选取2002年12月至2008年3月就诊的肝门部胆管癌患者43例作为研究对象,回顾性分析所有患者的临床表现、影像学检查结果、手术方式、生存率等临床资料,所有对象按手术方法分为根治性切除术组（22例）和姑息性切除术组（21例）,对比分析两组间患者的术后并发症发生率,1、3、5年生存率有无统计学差异。结果临床表现以黄疸最为常见,占86．0％,其次是尿黄（81．4％）和皮肤瘙痒（72．1％）;经过常规超声、CT及MRI联合检查,根治性切除术组和姑息性切除术组对肝门部胆管癌检出率分别为90．9％和95．2％;MRI诊断阳性率明显高于超声诊断阳性率（χ^2=7．379,P〈0．01）。根治性切除术组患者并发症发生率明显高于姑息性切除术组（χ^2=14．321,P〈0．01）,1、3、5年生存率也明显高于姑息性切除术组（r=6．018、χ^2=2．842、r=17．483,P〈0．05）。结论对于肝门部胆管癌患者,MRI诊断阳性率明显高于超声,采取超声联合CT或MRI可提高早期诊断率;根治性切除术治疗肝门部胆管癌,能够提高此类患者的远期存活率。     

The role of radiologic imaging and biopsy in renal tumor ablation

Purpose  

The rate of unintentionally discovered renal masses has been increasing along with a parallel increased incidence of renal cell carcinoma both in men and women. Ablation therapy has emerged as an alternative for the treatment of these small renal tumors. Several techniques have been developed for renal tumor ablation with cryoablation (CA) and radiofrequency ablation (RFA) being among the most widely used and studied. The purpose of this article is to review the role of imaging and renal mass biopsy in renal tumor ablation with focus on CA and RFA.     

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目的　探讨胃肠道间质瘤的临床表现、诊断及治疗。方法　回顾性分析上海建工医院及复旦大学华山医院外科 2000年 9月至 2003年 12月间收治 35例胃肠道间质瘤病人的临床及病理资料。结果　35例均行手术治疗。肿瘤根治 4例,近端或远端胃大部切除、病变肠段切除、肿块切除或扩大切除 26例;因肿瘤广泛粘连,无法完整切除 5例。病理:CD117阳性 29例(82 .9% ),CD34阳性 31例 (88 .6% )。结论　胃肠道间质瘤在中老年人中好发,以便血、腹痛和腹部不适、腹部肿块表现为主。肿瘤的大小是胃肠道间质瘤良、恶性的重要临床指标。病理形态学检查是确诊间质瘤的唯一方法。完整的局部手术切除是最有效的治疗手段。对无法切除或有肿瘤残余及术后复发的病人可应用甲磺酸伊马替尼(格列卫)进行治疗。     

肾上腺肿瘤影像学诊断的评价(附385例报告)

目的　提高肾上腺肿瘤的影像学诊断水平。　方法　肾上腺肿瘤患者 385例。男 15 8例 ,女 2 2 7例。平均年龄 38.2岁。行B超CT检查 385例 ,行IVU检查 380例 ,行MRI检查 180例 ,行Doppler检查 6 3例 ,行数字减影血管造影 (DSA) 16例 ,行MRA检查 2 8例 ,行间位碘代苄胍(MIBG)检查 34例 ,行CT引导下肾上腺肿块活检术 3例。　结果　B超对醛固酮腺瘤 (APA)、库兴腺瘤、嗜铬细胞瘤 (Pheo)、髓样脂肪瘤定位诊断正确率分别为 92 .7%、88.3%、10 0 .0 %、10 0 .0 % ,定性诊断正确率分别为 83.2 %、86 .7%、83.4 %、10 0 .0 % ;CT的定位诊断正确率分别为 98.2 %、98.7%、10 0 .0 %、10 0 .0 % ,定性诊断准确率分别为 90 .5 %、92 .3%、83.4 %、10 0 .0 % ;MRI的定位诊断正确率分别为 90 .4 %、96 .5 %、10 0 .0 %、10 0 .0 % ;定性诊断正确率分别为 72 .8%、93.5 %、85 .8%、10 0 .0 %。　结论　全面完整的影像学资料对肾上腺肿瘤的定性诊断有一定参考价值 ;正确的影像学定位资料 ,能指导手术方案选择。     

游离齿突小骨的影像学征象(附23例报告)

目的 经影像学研究探讨游离齿突小骨的影像学特征。方法 回顾分析23例游离齿突小骨患者，其中10例有明确的外伤史。明确游离小骨的诊断后，须经影像学检查来明确寰枢关节的不稳定程度和颈脊髓的压迫。1例无症状的患者行保守治疗，22例行手术治疗。结果 随访2～4年(平均2年8个月)，23例患者的临床和影像学结果均较满意。结论 对游离齿突小骨患者，无论有无寰枢椎不稳、有无症状和脊髓损伤的体征，均可成功进行影像学评估。建议对此类患者宜常规行颈椎正侧位、开口位、屈．伸侧位摄片和CT平扫，并根据实际情况尽可能行三维CT重建和MRI检查。     

肾上腺肿瘤的影像学诊断(附350例报告)

目的　提高肾上腺肿瘤的诊断水平。　方法　回顾 1 975年 5月～ 1 998年 5月收治的肾上腺肿瘤 35 0例临床资料 ,总结影像学检查与临床症候群、病理组织类型的关系。　结果　B超和CT对肾上腺肿瘤的定位诊断率分别为 85 %和 96 %。在皮质腺瘤、嗜铬细胞瘤及肾上腺皮质癌等不同的组织类型间 ,CT和MRI具有相对特异的表现。　结论　影像学检查可以提供肾上腺肿瘤的定位和定性诊断 ,在诊断和治疗中具有重要的应用价值。     

18例血管球瘤的诊治分析

目的探讨血管球瘤的临床、辅助检查和组织学特点 ,以及手术治疗的效果。方法回顾性分析 1992～ 2 0 0 2年手术治疗的 18例血管球瘤的临床资料。结果 18例血管球瘤中 ,男女比例为 1 6∶1(11∶7) ,平均年龄 (39± 7)岁 ,多发瘤占 11 1% (2 / 18)。 6 1 1%病例 (11/ 18)发生于四肢指 (趾 )甲下或末端 ,88 9%病例 (16 / 18)肿瘤直径小于 10mm。临床误诊率高达 6 1 1% (13/ 18)。B超在除四肢指 (趾 )甲下或末端外血管球瘤中的发现率为 85 7% (6 / 7) ,而X线检查发现率仅 33 3%(4 / 12 )。组织学检查示 2例 (2 / 18)诊断为实性型血管球瘤 ,16例为血管瘤型血管球瘤。 10例行免疫组化检查 ,Vementin均呈阳性。结论对于发生于四肢指 (趾 )甲下或末端以外部位的血管球瘤由于缺乏特异性的症状和体征诊断较难。手术治疗是该病的首选治疗方法。     

外科医生读片的艺术

研究外科医生提高影像诊断的艺术.首先,影像医生与外科医生读片在方法上存在本质性的区别.影像医生读片是在自己的专业范围内“看图说话”,而外科医生读片既“看图说话”做出诊断;又“离图说话”,通过临床资料、病理学认知、联想与直觉,推断片外的病变.其次,总结外科医生读片的艺术.外科医生读片有四种艺术,分别是用眼看片、用脑读片、用心想片和用智识片.外科医生应在一专多能的基础上,通过基础知识与临床经验的积累以及创造性联想与分析,进一步提高读片的准确性,进而提高外科决策的正确性.     

胰腺实性假乳头状瘤的诊治(附4例)

Objective To discuss the management of solid-pseudopapillary tumor of the pancreas. Methods Four patients of solid-pseudopapillary tumor of the pancreas (SPT) were diagnosed by pathology. One patient was underwent magnetic resonance and two enhanced computer tomography scan. The mass was located in tuberculum (1 case), neck (1 case), and body-tail (2 cases) of pancreases respectively. Four cases were underwent duodenopancreatectomy, local resection of mass, resection of body-tail of pancreases respectively. The maximal diameter of tumor ranged from 5 cm to 16cm, averaged 10.3cm. The blood regular test and biochemistry were normal, and the tumor markers including AFP,CA19-9,CA125,CEA also were normal. The specimens were examined by pathology and immunohistochemistry. Results Four cases all were diagnosed solid-pseudopapillary tumor of the pancreas by pathology. At histologic analysis, the tumor was composed of uniform polygonal cells with moderate to abundant amphophilic cytoplasm and arranged in solid nests with areas of degeneration characterized by separation of the cells into pseudopapillary aggregates with intervening accumulation of mucopolysaccharide rich ground substance. The expressions of Vimentin, α-ACT, α-AAT were positive, and CgA negative. Four cases were followed up for six months and norecurred. Conclusions SPT of pancreases was a kind of tumor of low potential malignancy, and the magnetic resonance and computer tomography were often to be used. The effective therapy was thoroughly resection, and the prognosis in most patients is excellent.     

胰腺实性假乳头状瘤的诊治(附4例)

Objective To discuss the management of solid-pseudopapillary tumor of the pancreas. Methods Four patients of solid-pseudopapillary tumor of the pancreas (SPT) were diagnosed by pathology. One patient was underwent magnetic resonance and two enhanced computer tomography scan. The mass was located in tuberculum (1 case), neck (1 case), and body-tail (2 cases) of pancreases respectively. Four cases were underwent duodenopancreatectomy, local resection of mass, resection of body-tail of pancreases respectively. The maximal diameter of tumor ranged from 5 cm to 16cm, averaged 10.3cm. The blood regular test and biochemistry were normal, and the tumor markers including AFP,CA19-9,CA125,CEA also were normal. The specimens were examined by pathology and immunohistochemistry. Results Four cases all were diagnosed solid-pseudopapillary tumor of the pancreas by pathology. At histologic analysis, the tumor was composed of uniform polygonal cells with moderate to abundant amphophilic cytoplasm and arranged in solid nests with areas of degeneration characterized by separation of the cells into pseudopapillary aggregates with intervening accumulation of mucopolysaccharide rich ground substance. The expressions of Vimentin, α-ACT, α-AAT were positive, and CgA negative. Four cases were followed up for six months and norecurred. Conclusions SPT of pancreases was a kind of tumor of low potential malignancy, and the magnetic resonance and computer tomography were often to be used. The effective therapy was thoroughly resection, and the prognosis in most patients is excellent.