超声对肝门部胆管癌的分型在外科治疗中的价值

目的　探讨超声对肝门部胆管癌分型的可行性及在手术治疗中的应用价值。方法　根据Bismuth-CorletteⅠ～Ⅳ分型法，应用超声将28例肝门部胆管癌分为Ⅰ、Ⅱ、Ⅲa、Ⅲb、Ⅳ型，并与手术结果对照。比较各型肝门部胆管癌的手术方式。采用仪器为Aloka650,EUB420,探头频率3.5MHz。结果　超声对28例肝门部胆管癌的诊断率与分型准确率分别达96%和71%。施行切除术的病例数在Ⅰ+Ⅱ型与Ⅲb型之间差异无显著性意义(P＞0.05)，而Ⅳ型的手术切除率明显低于Ⅰ+Ⅱ型、Ⅲb型(P＜0.01，P＜0.05)。结论　超声是肝门部胆管癌术前无创性分型诊断的重要方法，对指导临床制定手术方案具有重要的应用价值。

Value of type determination with ultrasonography in surgical management of hilar cholangiocarcinoma

Objective To investigate the feasibility of type determination ofthe hilar cholangiocarcinoma with ultrasonography and its value in surgical management of the disease. Methods According to Bismuth-Corlette type determination of Ⅰ-Ⅳ, 28 cases of hilar cholangiocarcinoma were determined as types Ⅰ, Ⅱ, Ⅲa, Ⅲb and Ⅳ with ultrasonography. Meanwhile, they were compared with the results of surgery. The operative methods for each type were also compared. The apparatus are Aloka 650 and EUB 420 with 3.5 MHz probes. Results The ultrasonic diagnostic accordance rate of the 28 cases of hilar cholangiocarcinoma was 96%. The accurate rate of the ultrasonic type determination was 71%. The excision rate of types Ⅰ+Ⅱ was not markedly different from that of type Ⅲb (P>0.05). However, the excision rate of type Ⅳ was significantly lower than those of types Ⅰ, Ⅱ+Ⅲb (P<0.01 & 0.05). Conclusions Ultrasonography is an important non-invasive method for preoperative type determination of the hilar cholangiocarcinoma. Meanwhile, it is of important value in working out the operative regimens for treating the tumor in clinical practice.