超声造影在肝门部胆管癌术前评估中的应用价值

目的 评价实时谐波超声造影（CEUS）在肝门部胆管癌术前评估中的应用价值。方法 2007年1月至2013年4月复旦大学附属中山医院经手术病理证实的46例肝门部胆管癌患者，共46个肝门部胆管癌。采用χ^2检验比较肝门部胆管癌常规超声与CEUS回声分布差异；以手术确定的评估结果作为金标准，采用χ^2检验比较常规超声与CEUS判断胆管侵犯范围的准确率差异，采用Fisher确切概率法比较常规超声与CEUS诊断门静脉受侵的准确率、对肝门部淋巴结的显示率差异。结果 在CEUS门脉期及延迟期分别有82.6%（38/46）及91.3%（42/46）的肝门部胆管癌表现为低回声，与周围肝实质分界清晰，而常规超声63.0%（29/46）表现为边界不清的等回声，病灶清晰显示率在常规超声、CEUS门脉期及延迟期分别为37.0%（17/46）、84.8%（39/46）、91.3%（42/46）。肝门部胆管癌CEUS门脉期及延迟期回声分布与常规超声回声分布差异有统计学意义（χ^2=42.164、53.939，P=0.000）。CEUS判断胆管侵犯范围的准确率为100%（46/46），高于常规超声判断胆管侵犯范围的准确率80.4%（37/46），且差异有统计学意义（χ^2=7.882，P=0.005）。术中证实9例患者门静脉受侵，常规超声诊断7例患者门静脉受侵，CEUS诊断8例患者门静脉受侵，差异无统计学意义（P=1.000）。常规超声与CEUS均未发现肝动脉受侵。术中诊断8例患者伴肝门部淋巴结转移，常规超声及CEUS均发现6例患者伴肝门部淋巴结转移，差异无统计学意义（P=1.000）。结论 与常规超声相比，CEUS可提高肝门部胆管癌的病灶清晰显示率及对胆管侵犯范围的评估准确性。

Value of contrast-enhanced ultrasound in preoperative evaluation for hilar cholangiocarcinoma

Objective To evaluate the value of contrast-enhanced ultrasound （CEUS） in preoperative classification for hilar cholangiocarcinoma. Methods Forty-six patients with 46 hilar cholangiocarcinoma were diagnosed by surgical pathology in Zhongshan Hospital of Fudan University from January 2007 to April 2013. The echogenicity difference on conventinal ultrasound and CEUS were compared with chi-square test. The accuracy of conventinal ultrasound and CEUS for evaluating invaded bile duct, detective rates for portal vein invasion and displaying rate of metastatic hilar lymph nodes were compared with chi-square test or Fisher’s Exact test according to the golden standard of operative exploration. Results On CEUS, 82.6%（38/46） and 91.3%（42/46） hilar cholangiocarcinoma were hypoechoic in portal vein phase and delayed phase respectively, while 63.0%（29/46） hilar cholangiocarcinoma were isoechoic on conventinal ultrasound with vague margin. The clearly displaying rates were 37.0%（17/46）, 84.8%（39/46） and 91.3%（42/46） in conventinal ultrasound, portal vein and delayed phase of CEUS and the echogenicity was signiifcantly different. The evaluation accuracy of hilar cholangiocarcinoma invading bile duct was improved from 80.4%（37/46, conventinal ultrasound） to 100%（46/46, CEUS） significantly （χ^2=7.882,P=0.005）. Portal vein invasion were found in 9 cases during operative exploration and the detective rates on conventinal ultrasound and CEUS were 78%（7/9） and 89%（8/9） without signiifcant difference （P=1.000）. Metastatic hilar lymph nodes were found in 8 cases and the displaying rates on conventinal ultrasound and CEUS were the same （75%, 6/8） without signiifcant difference （P=1.000）. Conclusions CEUS could signiifcantly improve the clearly displaying rate of hilar cholangiocarcinoma and improve the evaluation accuracy for invaded bile duct comparing with conventinal ultrasound.