胆管下端梗阻性黄疸性疾病的64层螺旋CT表现

目的:探讨胆管下端梗阻性黄疸性疾病的64层螺旋CT表现和诊断价值。方法:回顾性分析2008年9月～2009年9月间84例胆总管下端梗阻患者的临床及影像资料,按良性和恶性分为两组:良胜组32例,包括单纯结石组21例和胆管炎11例(其中6例并发结石)。恶性组52例,其中胆管下段癌11例,壶腹部癌11例,胰头癌30例。所有病例均行CT平扫、动脉期及静脉期扫描,图像后处理采用MIP、MinIP、MPR、CPR等。CT观察指标包括:定量指标:胆总管内径、肝内I级胆管内径、胆总管壁厚度、梗阻部位距肝门部长度;定性指标:肿块有无、形态以及强化程度、肝内I级以远胆管扩张程度、范围、管壁强化程度、有无结石、有无双管征等。结果:所有病例均清晰显示。梗阻部位距离肝门部长度良、恶性组间差别明显(P0.01);而恶性组中胆管下段癌和胰头癌分别与壶腹部癌之间也有统计学差异(P0.05),其他指标各组间差别无显著性(P0.05)。结论:多层螺旋CT扫描及其重建方法能够清楚地显示胆管下端梗阻性黄疸性疾病,并有助于进行诊断和鉴别诊断。

Multi-slice CT in the diagnosis of obstructive inferior jaundice diseases

Objective：To discuss multi-slice CT appearances and diagnostic value in obstructive jaundice diseases.Methods：84 cases of obstructive inferior jaundice were researched between March,2008 and May,2009 and devided into two groups.Benign group included 21 cases of stones and 11 cases of cholangitis.Maligment group included 11 inferior cholangiocarcinoma,11 and 30 cases of pancreatic cancer.All cases underwent common and enhancement CT scan,which included arterial and venous phase.Quantitative indicators included diameter of common bile duct,intrahepatic bile duct diameter of I-level,common bile duct wall,obstruction of hepatic portal site from the Minister of degrees;Qualitative indicators included the availability of mass,shape and enhance the degree of intrahepatic bile duct beyond the expansion of I-level,extent,enhanced the degree of wall,with or without stones,twin-tube sign.Results：All patients were showed clearly.There were significant differences between benign and malignant groups in the distance from obstruction site to hilar（P0.01）.And in malignant group,there were significant differences in lower bile duct cancer,pancreatic cancer and ampullary cancer（P0.05）.Other indicators in each group had no significant difference（P0.05）.Conclusion：Multi-slice CT scans and reconstructed images can clearly demonstrate lower bile duct with obstructive jaundice diseases and contribute to the diagnosis and differential diagnosis.