胆管癌栓经皮肝穿刺胆管造影术的诊断价值.pdf

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1、·340·中国临床医学影像杂志2014年第25卷第5期JChinClinMedImaging，2014，Vo1．25，No．5胆管癌栓经皮肝穿刺胆管造影术的诊断价值孙巍，温锋，卢再呜，郭启勇(中国医科大学附属盛京医院放射科，辽宁沈阳110004)[摘要】目的：分析胆管癌栓经皮肝穿刺胆管造影术(Percutaneoustranshepaticcholangiography，PTC)的影像特点，以提高胆管癌栓的诊断水平。资料与方法：回顾性分析27例经病理或临床证实为胆管癌栓的PTC图像特点。患者年龄(49．81~7

2、．27)岁。27例患者均在超声或DSA引导下选择单侧或双侧穿刺人路行PTC，留置内引流管或外引流管，引流3～5d后复查PTC以观察影像变化情况。结果：27例胆管癌栓均于胆管腔内可见充盈缺损影，26例充盈缺损及相应水平胆管呈“膨胀性”改变。24例癌栓近端胆管呈软藤样扩张，3例呈枯树枝样改变，癌栓远端胆管均无扩张。9例充盈缺损的轮廓完全显示，其余18例部分显示。21例引流前后所见充盈缺损范围基本一致，6例引流后充盈缺损范围较前缩小。根据其累及范围分为3型：I型2例，Ⅱ型22例，Ⅲ型3例。结论：胆管癌栓有特异性的PT

3、C表现，PTC对胆管癌栓的诊断有重要价值。【关键词】胆管肿瘤；胆管造影术【中图分类号】R735．8；R814．43【文献标识码】A【文章编号】1008—1062(2014)05—0340—04DiagnosticvalueofpercutaneoustranshepaticcholangiOgraphyonbileducttumorthrombusSUNWei．WENFeng,LUZai—ming,GUOQi-yong(DepartmentofRadiology,ShengfingHospitalofChina

4、MedicalUniversity,Shenyang110004，China)Abstract：0bjective：Toanalyzepercutaneoustranshepaticcholangiography(PTC)imagingfeaturesofbileductcarcinomathrombus．MaterialsandMethods：PTCimagesof27patients(themeanagewas49．81±7．27yearsold)withhistologicallyprovedtohave

5、bileductcarcinomathrombuswerereviewedretrospectively．A1l27PTCwereperformedundertheguidanceofultrasoundorDSAbyselectiveunilateralorbilateralintrahepaticbileductpuncture．InternalorexternaldrainagewaskeptuntilrepeatedPTCwasperformedafter3-5dtoobservetheimagingc

6、hanges．Results：Fillingdefectsinbileductswereseenina1l27patients．Thefillingdefectsandinvolvedbileductsshowedexpandingappearancein26cases．Proximalbileductstotheinvolvedpartsweredilatedlikesoftcanesin24casesandfallenbranchesin3cases．Distalbileductsshowednodi-la

7、tioninanyofthecase．Thecontoursoffillingdefectswereclearlyshownin9casesandpartiallyshownin18cases．Twenty—onecasesshowedconstantfillingdefectswhile6caseshadshrunkenfillingdefectsafterdrainage．Threetypesweredefinedaccordingtotheinvolvedrange：TypeI，2case；TypeⅡ，2

8、2cases；TypellI，3cases．Conclusion：BileducttumorthrombushavesometypicalPTCimagingfeatures，PTCisusefulindetectinganddiagnosingbileducttumorthrombus．Keywords：Bileductneoplasms；Cholangiography胆管癌栓发生率