原发性肝细胞癌与胆管细胞癌的超声鉴别诊断研究

目的探讨原发性肝细胞癌（ＰＨＣ）与胆管细胞癌（ＣＧＣ）的超声诊断特点，以提高二者的超声鉴别诊断率。方法３０例ＰＨＣ和３０例ＣＧＣ病人均于术前行超声检查，使用３．ＳＭＨｚ的Ａｃｕｓｏｎ１２８ＸＰ／１０，Ａｌｏｋａ６５０等超声仪，观察病人的肝内回声、肿瘤位置、大小、胆管扩张等情况，并与手术病理进行对照分析。结果ＰＨＣ与ＣＧＣ的超声诊断准确率分别为８３％（２５／３０）和７７％（２３／３０），声像图见ＰＨＣ境界清楚，受侵犯的胆管位于肿瘤的边缘或远离肿瘤本体；而ＣＧＣ（境界不清，受侵犯的胆管位于肿瘤中。两组并发肝硬化和淋巴结转移及合并结石和脓疡的差异均非常有显著意义。结论ＰＨＣ与ＣＧＣ的声像图特征有很大的不同，超声诊断准确率高，由于二者的明确诊断与患者治疗方案和手术方式的选择明显有关，因此超声对二者进行鉴别诊断有重要临床意义。

Study of ultrasonic differential diagnosis between primary hepatocellular carcinoma and cholanglocarcinoma

Objective TO raise the ultrasonic differential diagnostic rates of the Primary hepatocellularcarcinare (PHC) and cholangiocarcinoma (CGC), by exploring the ultrasonographic characteristics of PHC andCGC. Methods Thirty cases of PHC and 30 cases of CGC were preoperatively examined by ultrasound. The ap-paratuses used were Acuson 128 XP/10, Aloka 650 etc. with 3.5 MHz Probe. The echoes of the liver, the locationand the size of the tumor, the dilatation of the bile duct etc. were observed and compared with operative and patho-lotic findings. Results The ultrasonic diagnostic accurate rates of PHC and CGC were 83% (25/30) and 77%(23/30), respectively. The bouxndary of PHC in the sonography was clear. The bile duct having been invaded bythe tumor often located at the edge of the tumor or not connected with it. However, the boundary of CGC in thesonography was not clear. The bile duct which was invaded located at the border or far from the tumor proper. Thedifferences between PHC and CGC complicated with hepatocirrhosis and lymphatic metastasis were marked as wellas between those complicated with biliary calculi and abcess. Conclusions As the ultrasonic characteristics ofPHC and CGC are quite different and the definite diagnoses of the two diseases are correlative with the selection oftherapy and Operation Program, it is important to differentaially diagnose the two diseases according to their differentsonographic characteristics.