中下段胆管癌的诊断和鉴别诊断

目的　探讨中下段胆管癌的诊断和鉴别诊断。方法　对 18例术前误诊为中下段胆管癌资料进行回顾性分析。结果　本组 9例经ERCP、6例MRCP、以及PTC、T管胆道造影、CT各 1例确定胆管狭窄部位。 16例经手术探查确定诊断 ,分别为 :胆总管损伤 3例 ,胆囊管与胆总管汇合点过低伴结石嵌顿 2例 ,胆囊癌转移灶 2例 ,胰腺癌 2例 ,胰腺结核 2例 ,慢性胰腺炎、胆总管结石、壶腹癌、十二指肠癌和腹腔结核各 1例 ;2例经随访治疗分别确定为腹腔结核和硬化性胆管炎。结论　单凭胆管狭窄的影像学资料难以将中下段胆管癌与许多病变相鉴别。应研究其术前和术中的诊断方法 ,提高诊断准确率 ,以便选择最适当的治疗方案

Diagnosis and differential diagnosis of carcinoma in the middle and distal bile duct

Objective To explore diagnosis and differential diagnosis of carcinoma in the middle and distal bile duct. Methods We performed a retrospective study of 18 cases of cholangiocarcinomas. Results Pre-operative imaging techniques accurately shown stenosis of bile duct, including ERCP (9 cases), MRCP 6 cases, PTC, T tube cholangiography and CT (1 cases) respectively. The post-operative diagnosis of 16 cases were: common bile duct (CBD) injury (3 cases), cholecystolithiasis with cystic duct and common bile duct confluence excessively low (2 cases), metastasic lesion of carcinoma of gallbladder (2 cases), pancreatic carcinoma 2 cases, pancreatic tuberculosis (2 cases), and chronic pancreatitis, CBD stone, ampullar carcinoma, duodenal carcinoma, abdominal cavity tuberculosis 1 cases respectively. One abdominal cavity tuberculosis and one sclerosing cholangitis were diagnosed after treatment. Conclusions Pre-operative diagnosis and differential diagnosis of carcinoma in the middle and distal bile duct base on stenosis of bile duct by imaging techniques is unaccurate. Further methods have to be taken to improve the accuracy of pre-operative diagnosis.