肝细胞癌胆管转移的超声诊断

目的：总结18例肝细胞癌胆管转移的影像学特征，探讨超声诊断本病的依据及与胆管癌的鉴别诊断。方法：回顾性收集749例阻塞性黄疸的临床资料，对其中18例经手术、病理证实为肝细胞癌胆管转移的影像资料进行分析。结果：18例肝细胞癌胆管转移约占全部阻塞性黄疸病例的2.4％，超声诊断本病的符合率约66.7％（12/18）。主要超声表现为：肝实质回声增强增粗，分布欠均匀，部分（10/18）肝内可见边界模糊、形态不规则的强回声斑块；胆总管上段及肝内胆管明显扩张，在扩张的胆管下端可见较规则的实性肿块，以椭园形等回声居多（11/18）；肿块与胆管壁的界限大多清楚（15/18），胆管壁无增厚及回声增强，胆管腔无鼠尾状狭窄。结论：肝细胞癌胆管转移有其特征性图像，有别于胆管癌，若结合CDFI或介入穿刺细胞学检查可提高诊断的符合率。

Ultrasonic Diagnosis of the Hepatocellular Carcinoma with Bile Duct Metastasis

Objective The diagnostic basis of the hepatocellular carcinoma with the bile duct metastasis(HCBDM) and differential diagnosis from cholangiocarcinoma(CC) by ultrasonic were studied. Methods The clinical data of 749 cases with obstructive jaundice were collected retrospectively, and among them 18 cases of HCBDM, identified by operation and pathology were analysed. Results Eighteen cases of HCBDM took up 2.4% in all patients with obstructive jaundice(18/749), the coincidence rate of ultrasonic diagnosis was about 66.7%(12/18). The major ultrasonic findings in these patients were rough and strengthened echoes of hepatic parenchyma with uneven distribution;dim border and irregular strong echoes plague(11/18) in liver;obvious dilation of upper segment of common bile duct and intrahepatic bile duct and a regular substantial mass at the lower end of dilated bile duct with elliptic echoes mostly; most cases with distinctive borders between the mass and the wall of bile duct 15/18, without thickening of bile duct wall and strengthening echo, without rat-tailed stricture in the cavity of bile duct. Conclusion The HCBDM has its characteristic ultrasonic image which can be differentiated from cancer of biliary duct. The diagnostic coincidence rate should be improved if performing ultrasonography combined with CDFI (color Doppler flow imaging) or the interventional puncture cytological examination.