CT三维重建在肝门部胆管癌的诊疗中的应用价值

目的:探讨术前CT三维重建在肝门部胆管癌的诊断和可切除性评估中的应用价值。方法:回顾性分析安徽医科大学附属省立医院自2015年1月—2016年12月收治的15例肝门部胆管癌患者资料,所有患者术前常规行CT三维重建,分析肿瘤的位置与毗邻关系以及Bismuth分型,从而进行手术的可切除性评估。结果:15例患者均完成手术探查,其中Bismuth分型Ⅱ型1例,Ⅲ型5例(Ⅲa型2例,Ⅲb型3例),Ⅳ型9例,其中根治性手术11例,姑息性切除术4例。CT三维重建在术前诊断肝门部胆管癌分型、肿块与门静脉及肝动脉比邻关系、肿块体积的准确率分别为93.3%、86.7%、53.3%、93.3%;术前模拟手术与实际手术方式符合率为80%。结论:术前CT三维重建可以准确、直观、动态的显示肝门部胆管癌及三维毗邻关系,对于判断肝门部胆管癌的可切除性具有较高的准确性,值得临床推广。

Application value of three-dimensional reconstruction of CT scan images in diagnosis and treatment of hilar cholangiocarcinoma

Objective: To investigate the application value of three-dimensional reconstruction of CT scan images in diagnosing and the resectability assessment of hilar cholangiocarcinoma.Methods: The clinical data of 15 patients with hilar cholangiocarcinoma treated in the Affiliated Provincial Hospital of Anhui Medical University from January 2015 to December 2016 were retroprospectively studied. Before operation, all patients underwent three-dimensional CT reconstruction, and the locations of the tumors and their relations with the surrounding structures as well as their Bismuth classifications were analyzed and thereafter, the surgical resectabilities of the tumors were judged.Results: Of the 15 patients, all cases underwent surgical exploration; Bismuth classification was type II tumor in one case, type III tumor in 5 cases (type IIIa in 2 cases and IIIb in 3 cases) and type IV tumor in 9 cases respectively; 11 cases underwent radical operation and 4 patients had palliative resection. The diagnostic accuracy of three-dimensional CT reconstruction for tumor classification, and tumor relation with the portal vein and the hepatic artery, and mass volume was 93.3%, 86.7%, 53.3% and 93.3%, respectively. The coincidence rate of preoperative simulation operation and actual operation was 80%.Conclusion: The preoperative three-dimensional CT reconstruction can accurately, directly and dynamically display the hilar cholangiocarcinoma and its three-dimensional relations with adjacent structures, and has high accuracy in judging the resectability of the hilar cholangiocarcinoma. So it is recommended to be used in clinical practice.