胆总管下段软组织病变的超声诊断

目的　探讨胆总管下段软组织病变的超声检查及其临床意义。　方法　对 87例胆总管下段软组织病变的超声诊断结果与手术病理或随访结果进行对照。　结果　超声检查怀疑胆总管癌 16例 ,术后病理诊断为胆总管癌 12例 ,壶腹癌 4例。超声检查怀疑壶腹癌 18例 ,术后病理诊断为壶腹癌 15例 ,胆总管癌 2例 ,软组织炎症 1例。超声检查拟诊为胰头癌 4 0例 ,均与术后病理诊断结论相符。超声检查怀疑十二指肠乳头癌 7例 ,术后病理诊断为十二指肠乳头癌 5例 ,壶腹癌 2例。胆总管癌合并胆总管下段结石 4例 ,其中 3例超声检查胆总管癌漏诊。2例超声诊断无法确定病变性质 ,随访结果为软组织炎症。超声诊断结果与病理诊断或临床随访结果相符率为 83.9%(73/87)。　结论　超声检查对胆总管下段软组织病变与胆总管结石容易鉴别 ,对软组织病变的良恶性病变鉴别有困难 ,必要时应结合十二指肠镜或 ERCP检查

The Ultrasonic Diagnosis of Pathological Changes in Distal Part of Common Bile Duct

Objective\ To investigate the ultrasonography and its clinical significance in diagnosis of soft tissue pathological changes in distal part of common bile duct.\ Methods\ Compared the ultrasonic dignosis of 87 cases with operation and pathology.\ Results\ In ultrasonic diagnosis of common bile duct cancer 16 cases, the pathological diagnosis was common bile duct cancer 12 cases and carcinoma of ampulla of Vater in 4 cases.\ In ultrasonic diagnosis of carcinoma of ampulla of Vater 18 cases, the pathological diagnosis was carcinoma of ampulla of Vater 15 cases and common bile duct cancer in 2 cases, inflammation in 1 case.\ In ultrasonic diagnosis of pancreas head carcinoma 40 cases, all was identified correctly in pathological diagnosis.\ In ultrasonic diagnosis of duodenum cancer 7 cases, the 5 cases was correct and another carcinoma of ampulla of Vater 2 cases were identified.\ Pathological diagnosis of 4 cases cholelith accompanied common bile duct carcinoma, that was all ignored by it runing the cholelith images in examination.\ 2 cases had uncertain impression, which identified by pathological examination belong to soft tissue inflamation.\ Total accordant rate in ultrasonic examination was 83 9%(73/87).\ Conclusion\ Soft tissue pathological changes of distal part of common bile duct can be easily identified, but it is difficulty to distinguish whether it's beingn or malignant tumor, duodenoscopy or ERCP can be helpful for these cases.