肝门部胆管癌术前诊断方法的研究  

Study on preoperative diagnosis of hilar cholangiocarcinoma

作　　者：王炳生[1] 焦宛[1] 刘厚宝[1] 屠金夫[1] 陈财忠[2] 曹永胜[2] 史留生[3] 

机构地区：[1]上海医科大学附属中山医院外科,200032 [2]上海医科大学附属中山医院放射科,200032 [3]上海医科大学附属中山医院病理科,200032

出　　处：《中国实用外科杂志》1998年第6期339-342,共4页Chinese Journal of Practical Surgery

基　　金：卫生部科学基金

摘　　要：对20例肝门部胆管癌的术前诊断方法进行研究。结果提示：胆汁脱落细胞检查、刷取细胞检查和钳取组织活检的阳性率分别为10％、52．6％和75％。联合应用三种检查方法可使诊断的敏感性提高到84．2％。60％的病人血清CA19－9值显著升高，达正常值的6倍以上。B超、电脑彩超、CT和磁共振胆道成像的确诊率分别为55％、85％、55％和91．4％。肝门部胆管癌的术前诊断可分两步进行。首先，通过B超结合临床资料对病人初步筛选，然后采用三项检查法：（1）血清CA19－9值测定（若＞222kU／L）；（2）电脑彩超；（3）磁共振、磁共振胆道成像或螺旋CT胆道成像。如果两项以上检查结果提示肿瘤征象，则可基本上确诊为肝门部胆管癌。Using deferent kinds of diagnostic methods, a preoperative diagnosis was studied in 20 patients with hilarcholangiocarcinoma. The results showed that the positive rates of bile cytology, bruch cytology, and forceps biopsy were 10%,52.4%,and 75 % respectively. Combined three kinds of technics made diagnostic sensitivity elevate to 84 .2%. Theserum level of CA19-9 elevated markedly in 60 percent of patients, its value was 6 times or more higher than normallevel. The accuracy rates of B mode sonography, computed sonography, CT, and MRI combined with MRC in this serieswere 55 %, 85 % 1 55 %, and 91 .4 % respectively. Prooperative diagnosis of hilar cholangiocarcinoma can be performedthrough 2 steps, first of all patient is screened out by B mode sonography and clinical data, and then the followingdiagnostic methods #a,e used: (1 )measurement of serum level of CA19 9 (if its value > 222hUm). (2)computed sonography.(3) MRI combined with MRC or spiral CT cholangiography. If 2 kinds or more of results indicated tumor's signs, a firmdiagnosis of hilar cholangiocarcinoma is made essentialyy.

关 键 词：肝门部 胆管肿瘤 诊断 手术前 

分 类 号：R735.804[医药卫生—肿瘤]