超声检查在胆道下段阻塞性黄疸恶性病变中的应用价值

目的：探讨二维、彩色多普勒及超声造影技术在胆道下段阻塞性黄疸恶性病变中的声像图特征。方法：应用二维、彩色多普勒及超声造影技术对经病理证实的88例胆道下段阻塞性黄疸恶性病变即胰腺癌、胆管癌、壶腹癌患者观察其胆总管梗阻的程度、胰管增宽情况及肿瘤位置、大小形态、包膜边界、内部结构、血流状况等图像特征。胰腺癌中6例胰头癌患者进行超声造影。结果：88例恶性肿瘤患者中胰腺癌39例，胆管癌18例，壶腹癌31例。声像图特征：胆道下段阻塞性黄疸恶性病变均有肝内外胆管扩张、胆囊正常或增大、胰管扩张。胰腺癌包括胰头癌35例、胰体癌2例及胰尾癌2例，可有大小不等肿瘤，周围血流包绕。超声造影胰腺癌肿瘤本身与周围胰腺组织相比，表现出略低于正常胰腺的增强强度模式，时相呈典型低增强，造影剂充填分布不均，廓清时间早于正常胰腺组织，肿瘤病灶的大小和边界以及与胰腺周围动静脉的关系显示更清晰。胆管癌18例中，截断型2例，肿块型5例，漏斗型11例。壶腹癌31例。误诊8例：胰腺癌4例漏诊，胆管癌2例误诊，壶腹癌2例漏诊，诊断符合率为90．9％（80／88）。全部经病理证实。结论：引起胆道下段阻塞性黄疸之恶性肿瘤二维及彩色多普勒声像图根据其特征可作出诊断，对不典型图像还可采用超声造影技术进行确诊，有利于临床治疗方案的制定和术后疗效的评估。

The value of ultrasound examination in jaundice obstructive biliary malignant lesions of lower segment

Objective：To investigate sonographic characteristics of the two -dimensional, color Doppler and con- trast -enhanced ultrasound in jaundice obstructive biliary lower malignant lesions. Methods：By using 2D and color Doppler ultrasound technology, to test 88 cases of biliary pathology section malignant obstructive jaundice disease. Re- suits：There were 39 cases of pancreatic carcinoma in 88 cases of malignant tumors, 18 cases of bile duct carcinoma, 31 cases of carcinoma of ampulla. Conclusion：Cause of the malignant tumor of biliary obstructive jaundice under sec- tion of the two - dimensional and color Doppler ultrasonographic diagnosis can be made according to its characteris- tics ,for those not typical image can also be diagnosed by ultrasound technology.