胆管癌栓经皮肝穿刺胆管造影术的诊断价值  

Diagnostic value of percutaneous transhepatic cholangiography on bile duct tumor thrombus

作　　者：孙巍[1] 温锋[1] 卢再鸣[1] 郭启勇[1] 

机构地区：[1]中国医科大学附属盛京医院放射科,辽宁沈阳110004

出　　处：《中国临床医学影像杂志》2014年第5期340-343,共4页Journal of China Clinic Medical Imaging

摘　　要：目的：分析胆管癌栓经皮肝穿刺胆管造影术（Percutaneous transhepatic cholangiography，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±7.27）岁。27例患者均在超声或DSA引导下选择单侧或双侧穿刺入路行PTC，留置内引流管或外引流管，引流3~5 d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PTC表现，PTC对胆管癌栓的诊断有重要价值。Objective： To analyze percutaneous transhepatic cholangiography （PTC） imaging features of bile duct carcinoma thrombus. Materials and Methods： PTC images of 27 patients （the mean age was 49.81＋7.27 years old） with histologically proved to have bile duct carcinoma thrombus were reviewed retrospectively. All 27 PTC were performed under the guidance of ultrasound or DSA by selective unilateral or bilateral intrahepatic bile duet puncture. Internal or external drainage was kept until repeated PTC was performed after 3-5 d to observe the imaging changes. Results： Filling defects in bile ducts were seen in all 27 patients. The filling defects and involved bile ducts showed expanding appearance in 26 cases. Proximal bile ducts to the involved parts were dilated like soft canes in 24 cases and fallen branches in 3 cases. Distal bile ducts showed no dilation in any of the case. The contours of filling defects were clearly shown in 9 cases and partially shown in 18 eases. Twenty-one cases showed constant filling defects while 6 cases had shrunken filling defects after drainage. Three types were defined according to the involved range： Type Ⅰ, 2 case; Type Ⅱ, 22 cases; Type Ⅲ, 3 cases. Conclusion： Bile duct tumor thrombus have some typical PTC imaging features, FFC is useful in detecting and diagnosing bile duct tumor thrombus.

关 键 词：胆管肿瘤 胆管造影术 

分 类 号：R735.8[医药卫生—肿瘤] R814.43[医药卫生—临床医学]