多层螺旋CT对肝门胆管癌分型诊断的价值

目的 探讨多层螺旋CT(MSCT)分型在肝门胆管癌可切除性评价中的作用.方法 回顾性分析经手术病理证实且术前MSCT定性诊断为肝门胆管癌的患者30例,对MSCT轴面图像及多平面重组(MPR)图像进行分析,评价肿瘤病灶的Bismuth-Codette分型及大体形态分型,并与手术病理结果进行对照分析.采用卡方检验比较不同Bismuth-Corlette分型和不同大体形态分型患者行根治性切除术的情况.结果 30例肝门胆管癌患者中,Bismuth-Corlette分型Ⅰ型、Ⅱ型、Ⅲa型、Ⅲb型和Ⅳ型分别为1、3、4、5和17例,其中17例行根治性切除术,Ⅰ型、Ⅱ型、Ⅲa型、Ⅲb型和Ⅳ型分别为1、2、1、4和9例,不同Bismuth-Corlette分型患者行根治性切除术的差异无统计学意义(X2=0.9875,P＞0.05).MSCT对Bismuth-Corlette分型的总准确率达86.7%(26/30).大体形态分型为浸润型、外生肿块型及管内结节乳头型的患者分别为13、13和4例,分别有6、8和3例行根治性切除术,不同大体形态分型患者行根治性切除术的差异无统计学意义(X2=1.2583,P＞0.05).MSCT对肿瘤大体形态分型的诊断准确率达100%(30/30).结论 MSCT能作出较为准确的Bismuth-Corlette分型及肿瘤大体形态分型诊断,为肿瘤可切除性的判断提供重要依据.

Value of multi-slice CT in the dassification diagnosis of hilar cholangiocarcinoma

Objective To evaluate the value of multi-slice CT(MSCT)classification in the assessment of the hilar cholangiocarcinoma resectahility.Methods Thirty patients with surgically and histopathologically proved hilar cholangiocarcinomas who underwent preoperative MSCT and were diagnosed correctly were included in present study.Transverse images and reconstructed MPR images were reviewed for Bismuth-Corlette classification and morphological classification of hilar cholangiocarcinoma.Thcn MSCT classification was compared with findings of surgery and histopathology.Curative resectabilty of different types according to Bismuth-Corlette classification and morphological classification were analyzed with chi-square test.Results In 30 cases,the numbers of Type Ⅰ,Ⅱ,Ⅲa,Ⅲb and Ⅳ according to BismuthCorlette classification were 1,3,4,5 and 17.Seventeen patients underwent curative resections,among which 1,2,1,4 and 9 belonged to Type Ⅰ,Ⅱ,Ⅲa,Ⅲb and Ⅳ respectively.However,there was no significant difference in curative resectability among different types of Bismuth-Corlette classification(X2=0.9875.P＞0.05).In present study,the accuracy of MSCT in Bismuth-Corlette classification reached 86.7%(26/30).The numbers of periducatal infiltrating,mass forming and intraductal growing type were 13,13 and 4,while 6,8 and 3 cases of each type underwent curative resections.There was no significant difference in curative resectability among different types of morphological classification(X2=1.2583,P＞0.05).The accuracy of MSCT in morphological classification was 100%(30/30)in this study group.Conclusion MSCT can make accurate diagnosis of Bismuth-Corlette classification and morphological classification.which is helpful in preoperative respectability assessment of hilar cholangiocarcinoma.