MSCT联合 MPR对原发性胆管癌可切除性评价.doc

MSCT联合 MPR对原发性胆管癌可切除性评价 　 作者：刘盈洲　丁维宝　李加起　王玉许　李森 【摘要】 目的：探讨多层螺旋CT(MSCT)、多层面重建技术(MPR)、磁共振胆胰管成像(MRCP)、超声在原发性胆管癌患者术前可切除性评价的可信度。方法：对92例原发性胆管癌患者资料进行回顾性分析，术前行MSCT联合MPR检查者59例为实验组，行MRCP联合彩色多普勒超声等检查者33例为对照组，对比可切除判断的准确度。结果：实验组59例中术前评估可切除34例，实际切除32例，阳性预测值94.12%;对照组中33例中术前评估可切除28例，实际切除12例，阳性预测值42.86%;实验组与对照组之间阳性预测值差异有统计学意义(Plt;0.05)。结论：MSCT联合MPR检查在原发性胆管癌可切除性的术前评价中有较高的可信度。 【关键词】 胆管肿瘤·体层摄影术，螺旋计算机·磁共振胆胰管成像 　　【ABSTRACT】 Objective: To investigate the effect of resectability by multislice spiral computer tomography and multiplanar reconstruction to the patients with protopathic cholangiocarcinoma. Methods: 92 patients were analyzed with retrospective method, 59 patients detected by MSCT、MPR were included in experimental group, 33 patients detected by MRCP and sonography were as control group, the superiority of the resectability were compared in statistics method. Results: 34 patients were assessed resectable in experimental group and 32 patients were actually excisional，the positive predictive value was 94.12%; 28 patients were assessed resectable in control group and 12 patients were actually excisional, the positive predictive value was 42.86%. There were significant differences in predictive value. Conclusion: MSCT and MPR has a higher reliability coefficient in assessing resectability to the patients with protopathic cholangiocarcinoma. 　　【KEY WORDS】 Bile duct neoplasms·Tomography,spiral computed·Magnetic resonance cholangiopancreatography 　　原发性胆管癌是临床常见的恶性肿瘤之一，引发机体的多种病理生理改变[1]，手术风险较高，临床切除率低。如何较好地评估其可切除性一直是临床医师的目标。目前检查方法较为常用的有多层螺旋CT(MSCT)、多层面重建技术(MPR)、磁共振胆胰管成像(MRCP)、超声等[2]。本研究通过对92例原发性胆管癌患者术前行MSCT联合MPR和MRCP联合彩色多普勒超声评估其可切除性，对比不同检查方法的判断准确度。 　　1　资料与方法 　　1.1　一般资料　收集2005年1月—2008年12月潍坊市人民医院肝胆外科收治的原发性胆管癌患者92例，男53例，女39例，年龄37～83岁，中位年龄61岁。手术均由我院肝胆外科施行。其中行MSCT联合MPR检查者59例为实验组，行MRCP联合彩色多普勒超声等检查者33例为对照组。肝功能Child分级均为A级或B级。2组年龄，并发症(包括糖尿病、心血管病、高血压等)以及Ⅱ、Ⅲ期的病例数差异均无统计学意义(Pgt;0.05，表1)。 　　1.2　影像学评估　由1位主任医师和2位副主任医师共同参与术前影像分析。读片的内容包括：1)肝内外胆管扩张的范围、形态及程度;2)梗阻的部位，肿瘤的位置、大小和形态;3)肿瘤与周围组织的关系(近端梗阻主要观察肿瘤与肝蒂主要血管的