磁共振成像和磁共振胆道成像对肝门部胆管癌诊断和手术可切除性的估价

目的 探讨磁共振成像（MRI）和磁共振胆道成像（MRC）联合应用对肝门部胆管癌的诊断及手术可切除性的估价。方法 从1997年3月至1999年5月在对280例阻塞性黄疸进行了经肝脏MRI和MRC检查中，有38例诊断为肝门部胆管癌（13.6%,38/280)，并经手术和病理证实。结果 38例肝部部胆管癌中，24例MRI平扫，在肝门区可见较高信号肿块影，14例行增强扫描，8例可见病灶呈不均匀性强化，MRI肿瘤的显示率为84%（32/38）。MRI发现4例肝转移，7例门静脉主干或分支受累，MRC均可见肝门区阻塞，肝内胆管扩张，MRC定位准确性为100%。本组切除率为24%（9/38），其中I型4例，Ⅱ型3例，Ⅲ型a、b各1例，Ⅳ型无1例能切除，本组手术不能切除的原因主要为肝转移、肝门部肿块已侵及门静脉或肝动脉，结论 MRI和MRC联合应用有助于肝门部胆管癌的诊断及评估手术的可切除术。

MRI and MRC for the diagnosis of hepatic hilar cholangiocarcinoma and assessment of tumor resectability

Objective　 To evaluate the role of MR imaging (MRI) and MR cholangiography (MRC) for the diagnosis of hepatic hilar cholangiocarcinoma (HHC) and assessment of tumor resectability. 　Methods　 MRI and MRC were performed in 280 patients with obstructive jaundice from Mar.1997 to May.1999. The diagnosis of HHC was proved in 38 cases (13.6%, 38/280) by laparotomy and pathology. Imaging features and classification as related to surgical therapy of the tumor were analyzed. 　Results　 Tumor was identified in 24 out of 38 HHC cases. The contrast enhancement scanning further found tumors in 8 out of 14 HHC cases,with a total rate of tumor finding of 84% (32/38). MRI also suggested hepatic metastasis in 4 cases, portal vein invasion in 7 cases. MRC found hilar obstruction and dilatation of the intrahepatic biliary tree in all HHC cases. The surgical resection rate was 24%(9/38) including 4 cases of typeⅠ,3 cases of typeⅡ,1 of type Ⅲa and 1 of typeⅢb. Resection was impossible or not worthwhile in cases with hepatic metastasis, invasion of portal vein and/or hepatic artery. 　 Conclusion　MRI and MRC plays an important role in the diagnosis of hepatic hilar cholangiocarcinoma and assessment of tumor resectability.