临床病理特征和内镜检查在壶腹部癌诊断中的价值  

Clinicopathologic Features and Value of Endoscopy in the Diagnosis of Ampullary Carcinoma

作　　者：许春芳[1] 陈卫昌[1] 蔡衍郎[1] 

机构地区：[1]苏州大学附属第一医院,215006

出　　处：《实用癌症杂志》2002年第4期386-388,共3页The Practical Journal of Cancer

摘　　要：目的　探讨临床病理特征和内镜检查在壶腹部癌诊断中的价值。方法　对经手术和病理证实的 2 8例壶腹部癌患者的临床资料进行回顾性分析和TNM分期。根据术前内镜、B超和CT的诊断结果与术后病理结果进行比较 ,评估三者诊断壶腹部癌的准确率。结果　 2 8例壶腹部癌中 ,黄疸占 82 .1%,腹痛占 35 .7%,Courvoisier′s征占 42 .8%。胆总管扩张 2 4例 ,胰管扩张 7例。息肉型癌 16例 ,溃疡型癌 8例 ,浸润型癌 4例。高分化腺癌 14例 ,中分化腺癌 13例。T3 、T4 期多有淋巴结转移。B超、CT诊断壶腹部癌的准确率分别为 35 .7%和 5 7.1%,显著低于内镜 ( 91.7%)的诊断率 (P <0 .0 1)。ERCP造影显示胆总管末端狭窄、不规则充盈缺损、胰胆管扩张等改变。结论　壶腹部癌临床主要特征为无痛性黄疸伴胆胰管扩张。内镜 (包括ERCP)是诊断壶腹部癌最可靠的方法。Objective To evaluate the clinicopathologic features and value of endoscopy in the diagnosis of ampullary carcinoma.Methods The clinicopathologic data of 28 patients with ampullary carcinoma were retrospectively reviewed and analyzed.Accuracy rates of ultrasonography,computerized tomography and endoscopy in the diagnosis of ampullary tumors were assessed compared with postoperative pathologic finding.TNM staging was performed.Results The leading symptoms of ampullary carcinomas were jaundice(82.1%),upper abdominal pain(35.7%).Courvoisier′s sign existed in 42.8 % of patients.24 patients had common bile duct dilation,and pancreatic duct dilation in 7 patients.Three macroscopic appearances of the tumor were identified,including polypoid protruding(16 cases),ulcerative masses(8 cases),or infiltrating masses(4 cases).Histologic examination revealed well differentiated adenocarcinoma in 14 patients,moderately differentiated adenocarcinoma in 13 patients.T 3,T 4 lesion had metastatic lymph nodes.About 35.7 percent of ampullary carcinoma could be detected by ultrasonography,57.1 percent by CT,and 91.7 percent by endoscopy(P<0.01).ERCP showed the distant stenosis of the bile duct,irregular infilling defect,and biliary or pancreatic duct dilation.Conclusion The leading clinical characteristics of ampullary carcinoma are painless jaundice companied by common bile duct dilation.Endoscopy has been shown to be superior to ultrasonography and CT for diagnosis of ampullary carcinoma.

关 键 词：临床病理特征 内镜检查 壶腹部癌 诊断 

分 类 号：R735[医药卫生—肿瘤]