磁共振多种显像在肝门部胆管癌术前肿瘤切除可行性的评估

目的　探讨MRI ,MRCP ,MRA对肝门部胆管癌的诊断价值及术前评估肿瘤切除的可行性。方法　对MR等显像技术诊断为肝门部胆管癌的 78例患者 ,根据肿瘤浸润范围、血管受累情况、有无肝叶萎缩及远处转移等指征 ,进行术前影像学评估 ,并通过与手术和病理对比 ,了解该显像方法对肝门部胆管癌手术与否作出评判的价值。结果　术前评估不能手术切除的 2 1例中 ,10例行手术治疗 ,术中发现及病理学检查与术前评估一致 ,证实不能切除 ,仅行引流。术前评估为潜在手术切除可能的 5 7例均行手术探查 ,肿瘤的定性、定位诊断的准确率为 10 0 % ;手术切除 40例 ( 70 .2 % ) ,其中 2 9例 ( 5 0 .9% )行治愈性切除 ,11例姑息性切除 ;其余 17例不能手术切除 ,原因包括术前漏诊门静脉管壁破坏 3例 ,肝动脉受侵 5例 ,术中发现腹腔内器官和 /或淋巴结转移 7例 ,肝实质广泛浸润 2例。结论　应用MR多种显像技术对肝门部胆管细胞癌的定位及定性诊断率高 ,并能较准确地评价肝门部胆管细胞癌的手术可切除性。肿瘤不能切除的主要原因在于肿瘤的转移和局部血管的侵犯。

The value of vary magnetic resonance imgings in the preoperative assessment of the resectability of hilar cholangiocarcinoma

Objective To study the value of various MR imaging techniques in the preoperative diagnosis and preoperative assessment of resectability in patients with hilar cholangiocarcinoma.Methods Seventy-eight (patients) with hilar cholangiocarcinoma were diagnosed by imaging of MRI/MRCP/MRA.Based on imaging (analysis) of the extent of local tumor invasion,vascular involvement,hepatic lobar atrophy and distant (metastasis),a preoperative imaging assessment of resectability was done in 78 patients.This preoperative (assessment) was compared with the surgical and pathological findings,so as to evaluate the imaging value in prediction of whether or not resection was feasible in patiens with hilar cholangiocarcinma.Results Of 21 (patients) with unresectable disease according to imaging evaluation, laparotomy was performed in 10 cases,and in all 10cases the tumor was proven not to be resectable at operation.Thus,the surgical and pathological (findings) were in accordance with the result of imaging.Surgical exploration was performed in 57 patients with potentially resectable disease according to imaging evaluation. In this group, the intra-operative diagnosis of the location and nature of tumor was to be in line with the preoperative assessment of imaging, The (diagnosis) accuracy rate was 100%, and 40 patients underwent resection,the resection rate was 70.2%. Of 40 (patients) with resection,29 patients underwent curative resection,the curative resection rate was (50.9)%;11 patients underwent palliative resection.The other 17 patients were found to have (unresectable) disease at laparotomy,including 3 portal venous involvement,5 hepatic arterial (invasion),7 metastatic disease,2 hepatic parenchymal massive involvement. These diseases were not found in pre-operative imaging evaluation.Conclusions MR multi-imaging techniques have high accuracy in the diagnosis of the location and nature of hilar cholangiocarcinoma,and could evaluate accurately the feasibility of resection in patients with hilar cholangiocarcinoma. The main causes of unresectability lie in metastasis of tumor and local vascular involvement.