MRCP在肝内胆管黏液性肿瘤诊断与可切除性评估中的应用  

Application of magnetic resonance cholangiopancreatogra- phy in the resectability evaluation for mucin-producing intrahepatic biliary tumor

作　　者：严茂林[1] 王耀东[1] 魏少明[1] 田毅峰[1] 赖智德[1] 游燊[1] 陈忠[1] 陈实[1] 

机构地区：[1]福建医科大学省立临床医学院、福建省立医院肝胆外科,福州350001

出　　处：《中华消化外科杂志》2013年第12期969-972,共4页Chinese Journal of Digestive Surgery

基　　金：福建省卫生厅医学创新课题（2009.CBX-11）;福建省卫生厅青年基金（2207-41）

摘　　要：由于肝内胆管黏液性肿瘤（MPIBT）的胆管内存在大量胶冻样黏液，影像学检查如超声、腹部CT、经皮肝胆管穿刺等难以在术前明确诊断，MRCP检查较少用于MPIBT评估肿瘤可切除J生。回顾J生分析2004年1月至2012年12月福建省立医院收治的10例行手术治疗并经病理检查证实的MPIBT患者的临床资料，探讨MRCP检查在术前明确MPIBT诊断及评估肿瘤可切除性中的作用。肝内胆管不对称性扩张和远离肿瘤的肝内外胆管扩张而无肝外胆管的突然截断是MPIBT的MRCP检查最主要特征。MRCP检查示病灶侧扩张胆管与相对正常胆管的交界线为肿瘤与正常胆管黏膜的移行处，从而术前判断MPIBT能否被切除以及采取适当的手术方式。根据术前手术规划，5例患者接受根治性的手术切除，5例行姑息性胆道引流。MRCP检查作为一种非侵袭性技术，是术前明确MPIBT的诊断与评估肿瘤可切除性的有效手段。A precise diagnosis of mucin-producing intrahepatic biliary tumor （MPIBT） based on ultrasonography, abdominal computed tomography and percutaneous transhepatic cholangiography was often imposible because of a large amount of mucin. Magnetic resonance cholangiopancreatography （MRCP） was rarely used for the preoperative diagnosis of MPIBT. The clinical data of 10 patients with MPIBT who received surgical treatment at the Fujian Provincial Hospital from January 2004 toDecember 2012 were retrospectively analyzed, and the value of MRCP in the diagnosis and resectability evaluation of MPIBT was investigated. Asymmetry of bile duct dilatation and the dila- tation of both extra- and intrahepatie bile duct distal to the tumor and without sudden interruption in extrahepatic bile duct was the most characteristic appearance of MPIBT on MRCP. The point between dilated bile duct and relatively normal bile duct was the border between tumor and normal bile duct mucosa, which decided whether the MPIBT should be chosen before surgery. According to preoperative planning, 5 patients underwent radical surgical resection and 5 received palliative biliary drainage. As a non-invasive technique, MRCP may be an effective means for the diagnosis and resectability evaluation of MPIBT.

关 键 词：肝内胆管黏液性肿瘤 诊断 治疗 磁共振胰胆管成像 

分 类 号：R735.7[医药卫生—肿瘤]