十二指肠乳头癌的精确诊断  

The price diagnosis of duodenal papillary carcinoma

作　　者：冯变喜[1] 

机构地区：[1]山西省人民医院普通外科,太原030012

出　　处：《中华肝胆外科杂志》2013年第7期481-486,共6页Chinese Journal of Hepatobiliary Surgery

摘　　要：正确诊断是准确外科治疗的前提。十二指肠乳头癌是阻塞性黄疸中一种比较常见的原因，但术前的影像诊断很少做出准确的定位、定性诊断，甚至导致临床误诊、误治，随后再行第二次手术。作者从2003年1月至2012年12月诊治十二指肠乳头癌29例，术前都做出准确的定位诊断和拟诊十二指肠乳头癌的定性诊断。通过临床一影像一病理的对照性研究，总结出十二指肠乳头癌几种影像检查（超声、CT、磁共振、PTC、T管造影）具有以下七项共同特点：（1）胆囊大，肝内外胆管全程重度扩张，或伴有胰管扩张；（2）横断面图像显示，胆、胰管并列扩张（双管征）；（3）横断面图像胆管在超低位（肾门水平）圆形扩张；（4）横断面图像有“苹果把征”；（5）冠状面图像显示，胆管在超低位（腰椎2水平）有截断、偏心性或不规则狭窄；（6）CT横断面在十二指肠内侧有占位；（7）MRCP在乳头部位出现不规则低信号占位。单独或联合影像检查，只要具有第一项和其他六项中的任何一项，就可做出十二指肠乳头癌的诊断，进而提高外科决策的正确性。Precise diagnosis is the premise of precise surgery. Duodenal papillary carcinoma is one cause of ob- structive jaundice, but the several preoperative diagnostic imaging investigations （including Ultrosonography, CT, MRI with MRCP, PTC, T-tube chalangiogrphy） can not make the correct diagnosis of the tumor in location and nature. In some cases, the error diagnoses resulted in error surgeries which led to reoperations. During a period of ten years from the beginning of 2003 to the end of 2012, 29 cases with the entity made the correct diagnosis by surgeons in location and partly correct in nature. Based on the experi- ence of these cases, comparing the data from clinic pictures, imaging findings and pathologic observations, seven common characters for the diagnostic imaging investigation were valu- able to make precise diagnosis of duodenal papillary carcino- ma. These common characteristics are listed as.. （1） dilated gallbladder, marked intra- and extrahepatic biliary ductal dil- atation in whole range, may combine dilation of pancreatic duct^（2） on cross-sectional imaging as a double-duct sign, which results from obstruction of both the distal commonbile duct and the proximal pancreatic duct~ （3） on cross-sec- tional imaging as a cyclo-dilatation at the level of renal hi lump（4） on cross-sectional imaging as a apple-stem sign, which results from dilated common bile duct and the normal- ly proximal pancreatic duct; （5） on coronal plane imaging at the level of second lumbar vertebrae as a cutoff, or eccentrici- ty, or irregular strcture; （6） on cross-sectional imaging of CT imaging as a mass located at duodenum near the side of pan- creas; （7） on MRCP examinations as a mass with hypointen- sity at the level of duodenal papilla. Any imaging examina- tion alone, or combined examination show first characteristic with any one of the other six characteristics,the diagnosis of duodenal papillary carcinoma may be made, subsequently fol- lowed by a correct surgical decision.

关 键 词：十二指肠肿瘤 诊断显像 外科手术 

分 类 号：R735.31[医药卫生—肿瘤]