摘要
目的以手术结果为标准,探讨多排螺旋CT(MDCT)检测肝门部胆管癌(HCCA)侵犯肝门部各级胆管的诊断效能。方法回顾性分析2013年1月至2015年12月经手术病理证实的HCCA患者的MDCT图像,判断肝总管、左右肝管汇合部、双侧二级胆管汇合部是否受侵犯,据Bismuth-Corlette法分型,并与手术病理结果比较。结果23例患者中,根据MDCT图像分型,Ⅰ型2例,Ⅱ型2例,Ⅲa型3例,Ⅲb型2例,Ⅳ型14例;手术病理分型Ⅰ型2例,Ⅱ型3例,Ⅲa型3例,Ⅲb型4例,Ⅳ型11例。MDCT对肝门部胆管受累检出的敏感度、特异度、准确率分别为:肝总管100%、100%、100%,左右肝管汇合部100%、100%、100%,左侧二级胆管汇合部100%、87.5%、95.7%,右侧二级胆管汇合部100%、66.7%、87.0%。MDCT对HCCA分型的准确度为87.0%,与手术病理分型具有良好的一致性(Kappa值=0.802,P=0.000)。结论尽管MDCT对HCCA的分型具有较高的准确性,但其对肝门部各段胆管受累的诊断效能并不一致,尤其对右侧二级胆管汇合部病变检出能力有限。
Objective To investigate the diagnostic capabilities of multi-detector spiral computed tomography （MDCT） in detecting the involvements at different levels of bile ducts in hilar cholangiocarcinoma （HCCA） taking the surgical resuh as a standard. Methods The MDCT images of 23 HCCA patients confirmed by surgery and pathology from January 2013 to December 2015 were analyzed retrospectively to judge whether the common hepatic duct, the confluence position of left and right hepatic ducts and the confluence position of bilateral grade 2 bile ducts were violated, and the typing was made according to Bismuth-Corlette classification, and the results were compared with those of the operation and pathology. Results According to MDCT images, there were 2 cases of type I ,2 cases of type I] , 3 cases of ]lI a, 2 cases of type lllb,and 14 cases of type IV. According to pathology results,there were 2 cases of type I ,3 cases of type I1,3 cases of Ilia,4 cases of type DI b, and 11 cases of type 1V in 23 patients. The sensitivity, specificity and accuracy of MDCT for detecting the involvement of hepatic hilar bile ducts were 100%, 100% and 100% in common hepatic duct, 100%, 100% and 100% in confluence position of left and right hepatic ducts, 100%, 87. 5% ,95.7% in confluence position of grade 2 left hepatic duct, 100% ,66. 7% and 87. 0% in confluence position of grade 2 right hepatic duct. The accuracy of MDCT for HCCA typing was 87. 0 % and had a good consistency with surgical and pathological typing （Kappa = 0. 802, P = 0. 000）. Conclusion Although MDCT has a higher accuracy, the diagnostic efficacy for the involvement in each segment of bile duct in the hepatic portal position is not consistent, especially the detection capability is limited for the lesion of confluence position of grade 2 right hepatic duct.
出处
《中国临床研究》
CAS
2017年第12期1593-1596,共4页
Chinese Journal of Clinical Research
基金
中国博士后科学基金面上资助项目(2015M581837)
江苏省自然科学基金青年基金(BK20161064)
