三维重建联合超声内镜检查在胆道肿瘤术前精准评估中的应用价值  

Application value of three-dimensional reconstruction combined with endoscopic ultrasono-graphy in preoperative accurate evaluation of biliary tract neoplasms

作　　者：张朋飞 梁荔 张明 邢国强 牛帅 逄淑东 安伟 Zhang Pengfei;Liang Li;Zhang Ming;Xing Guoqiang;Niu Shuai;Pang Shudong;An Wei(Department of Hepatobiliary Surgery,Shangdong Provincial Third Hospital,Ji'nan 250031,China)

机构地区：[1]山东省立第三医院肝胆外科,济南250031

出　　处：《中华消化外科杂志》2023年第12期1490-1494,共5页Chinese Journal of Digestive Surgery

基　　金：2022年度山东省医药卫生科技发展计划项目(202204010946)。

摘　　要：目的探讨三维重建联合超声内镜检查在胆道肿瘤术前精准评估中的应用价值。方法采用回顾性描述性研究方法。收集2019年1月至2022年10月山东省立第三医院收治的19例应用三维重建联合超声内镜检查胆道肿瘤患者的临床病理资料;男13例, 女6例;年龄为64(35~75)岁。术前行腹部增强CT薄层扫描后进行三维重建, 同时行超声内镜检查, 部分患者联合应用胆管腔内超声及经内镜逆行胰胆管造影、SpyGlass等内镜技术, 获取肿瘤组织进行活组织病理学检查。根据三维重建、超声内镜检查结果制订手术实施方案。观察指标:(1)三维重建情况。(2)超声内镜检查情况。(3)术前手术规划与实际手术对比。偏态分布的计量资料以M(范围)表示。计数资料以绝对数和(或)百分比表示。结果 (1)三维重建情况。19例胆道肿瘤患者三维重建图像均可立体显示肝脏、胆管、胰腺、血管及十二指肠形态, 其中肝门部胆管肿瘤4例, 胆总管中下段肿瘤14例, 肝内胆管肿瘤1例。19例患者三维重建准确率为18/19。(2)超声内镜检查情况。19例患者术前均进行超声内镜检查, 其中7例行内镜下活组织病理学检查, 检查结果均为异常增生或恶性肿瘤。活组织病理学检查率为7/19, 灵敏度为7/7。19例患者中, 2例超声内镜检查提示存在淋巴结转移可能, 术后组织病理学检查发现所清扫淋巴结均为阴性;其余17例超声内镜检查未发现淋巴结转移, 其中1例术中腹腔镜探查腹壁多发转移瘤。(3)术前手术规划与实际手术对比。19例患者中, 18例行根治性手术, 1例改行胆管引流治疗;术前手术规划与实际手术方式符合率为18/19。18例根治性手术患者术中出血量为336(50~1 500)mL;2例发生术后并发症。结论三维重建联合超声内镜检查, 可以精准测绘胆道恶性肿瘤大小、部位、侵犯胆管范围、周围组织的毗邻关系, 进行术前精准评�Objective To investigate the application value of three-dimensional(3D)recons-truction combined with endoscopic ultrasonography(EUS)in preoperative accurate evaluation of biliary tract neoplasms.Methods The retrospective and descriptive study was conducted.The clinico-pathological data of 19 patients with biliary tract neoplasms who underwent 3D reconstruction combined with EUS in the Shangdong Provincial Third Hospital from January 2019 to October 2022 were collected.There were 13 males and 6 females,aged 64(range,35-75)years.All patients underwent preoperative abdominal enhanced computer tomography(CT)thin-slice scan with 3D reconstruction combined with EUS.Some patients further received other endoscopic techniques such as intraductal ultrasonography,endoscopic retrograde cholangiopancreatography or SpyGlass cholangioscopy to obtain tumor tissues for histopathology evaluation.The surgical implementation protocol was developed based on the results of 3D reconstruction and EUS.Observation indicators:(1)results of 3D reconstruction;(2)results of EUS;(3)comparison between preoperative surgical protocol and actual intraoperative conditions.Measurement data with skewed distribution were represented as M(range),and count data were described as absolute numbers and/or percentages.Results(1)Results of 3D reconstruction.Results of 3D reconstruction in 19 patients with biliary tract neoplasms showed morphology of the liver,bile ducts,pancreas,blood vessels,and duodenum,including 4 cases of hilar cholangiocarcinoma,14 cases of middle and lower cholangiocarcinoma,and 1 case of intrahepatic cholangiocarcinoma.The accuracy of 3D reconstruction in 19 patients was 18/19.(2)Results of EUS.All 19 patients underwent preoperative EUS,including 7 cases obtained tumor tissue for histopathology evaluation,with the results indicating abnormal hyperplasia or malignant tumor.The rate of histopathology evaluation was 7/19,with the sensitivity as 7/7.Of 19 patients,results of EUS in 2 cases indicated positive of lymph node metastasis,but r

关 键 词：胆道肿瘤 三维重建 超声内镜 术前评价 诊断 

分 类 号：R735.8[医药卫生—肿瘤]