影像学检查对肝门部胆管癌可切除性评估的价值

摘要

Objective To investigate the value of imaging examination in assessing the surgical resectability of hilar cholan⁃giocarcinoma. Methods Radiographic data including CT and MRI of forty⁃three patients pathologically and surgically diagnosed as hi⁃lar cholangiocarcinoma were analyzed retrospectively. These data were as follows:the size of tumor, the length of invaded bile duct, the involved extent of portal vein and hepatic artery, the state of lymph node metastasis and distant metastasis and the involved scope of bile duct. Moreover, these cases were classified and staged respectively according to the criteria of improved“proposed T⁃staging” system, which were studied statistically concerning the relevance to surgical resectability. Results The resectability in infiltrating tumor cases was 8�3%, and that of mass⁃forming cases was 51�6%(P=0�017). The size of hilar cholangiocarcinoma and the length of involved bile duct measured by CT and MRI respectively had no influence on resectabilities(P>0�05). The resectabilities in cases of various Bismuth types were not statistically different(P>0�05). On the contrary, the resectabilities with various “proposed T⁃staging” types were statistically distinct ( P<0�01) , which declined with higher T⁃staging and the differences were significant( P<0�01) . Conclusion The resectability of infiltrative tumor cases is lower than cases of mass⁃forming tumors. Both the size of mass and the length of in⁃volved bile duct are not relevant to the resectability of carcinoma. The improved “proposed T⁃staging” system is superior to Bismuth classification system in assessing the resectability of hilar cholangiocarcinoma.%目的：探讨影像学检查对肝门部胆管癌可切除性的评估价值。方法对43例经术后病理组织学证实的肝门部胆管癌患者的CT及MRI资料进行回顾性分析，包括肿瘤的大小、胆管受侵犯的长度、肿瘤侵犯门静脉及肝动脉的程度、淋巴结转移及远处转移的情况、胆管受侵犯的范围及改良建议性T分期与可切除性的关系。结果浸润型肝门部胆管癌的可切除率为8�3％，肿块型的可切除率为51�6％（ P＝0�017）。不同肿块大小和肿瘤浸润胆管的长度组别间可切除率的差异无统计学意义（ P＞0�05）。 Bismuth分型各型可切除率的差异无统计学意义（ P＞0�05）。改良建议性T分期各期的可切除率的差异有统计学意义（ P＜0�01），且可切除率随T分期的增加而下降（ P＜0�01）。结论浸润型肝门部胆管癌的可切除率低于肿块型；肿块的大小和肿瘤浸润胆管的长度与肿瘤的可切除性均无关；改良建议性T分期较Bismuth分型在指导肝门部胆管癌的可切除性上更有价值。