三维超声对肝门胆管癌分型诊断的临床初步应用

摘要

目的 初步探讨三维超声在肝门胆管癌分型诊断中的应用价值.方法 对20例临床确诊的肝门胆管癌患者,分别运用二维和三维超声进行分型,使用表面光滑模式和最小回声模式对肝门部肿瘤及肝内胆道树三维重建.以手术及磁共振胰胆管造影(MRCP)确定的分型结果作为金标准,比较三维和二维超声对肝门胆管癌分型诊断的准确率.结果 本组20例患者中11例经手术证实,包括Ⅰ型、Ⅱ型各1例,Ⅲa、Ⅲb型各2例,Ⅳ型5例,9例经MRCP证实,均为Ⅳ型.20例均成功重建出肝门部肿瘤及邻近胆道树的空间结构.二维超声分型诊断正确13例,诊断错误7例,其中手术证实4例,MRCP证实3例,包括1例Ⅱ型误诊为Ⅰ型,1例Ⅲa型及1例Ⅲb型误诊为Ⅳ型,3例Ⅳ型误诊为Ⅲa型,1例Ⅳ型误诊为Ⅲb型.三维超声分型诊断正确19例,1例Ⅲb型经手术证实误诊为Ⅳ型.三维和二维超声对肝门胆管癌分型诊断的准确率分别为95.0%(19/20)、65.0%(13/20),三维超声对肝门胆管癌分型诊断准确率高于二维超声(χ2 =3.91,P＜0.05).结论 三维超声成像能够提供更加丰富的信息,对了解肝门胆管癌与胆道树的空间位置关系、明确肝门胆管癌的分型具有一定价值.%Objective To explore the diagnostic value of three-dimensional ultrasonography in hilar cholangiocarcinoma classification. Methods Twenty patients diagnosed as hilar cholangiocarcinoma according to clinical data were selected to perform two-dimensional and three-dimensional ultrasonography in order to get clear classification diagnosis. Using the smooth surface mode and the minimum echo mode,hilar tumors and intrahepatic bile duct tree were successfully reconstructed. Accuracy rate of three-dimensional and two-dimensional ultrasonography on classification diagnosis of hilar cholangiocarcinoma were compared according to the surgery and magnetic resonance cholangiopancreatography( MRCP ) diagnostic classification which were identified as the gold standard. Results Eleven of 20 patients in this group were confirmed by the operation, including each one case of type I and type II , each two cases of type III a and III b, and five cases of type IV. Nine cases were diagnosed as type IV by the MRCP. The spatial structure of hilar tumor and adjacent intrahepatic bile duct tree in all 20 patients were successfully reconstructed. By two-dimensional ultrasonography, the classification diagnosis was correct in 13 cases,and incorrect in 7 cases, of which 4 cases were confirmed by surgery, the remainder by MRCP, including: 1 case type II misdiagnosed as type I , 1 case type III a and 1 case type III b as type IV, 3 cases type IV as type Ⅲa, and 1 case type IV as type m b. By three-dimensional ultrasonography, the classification diagnosis was correct in 19 cases, 1 case type m b, confirmed by surgery, were misdiagnosed as type IV ? Accuracy rate of three-dimensional and two-dimensional ultrasonography on classification diagnosis of hilar cholangiocarcinoma were 95. 0%( 19/20 )and 65. 0% ( 13/20 ), respectively. Accuracy rate of three-dimensional ultrasonography was higher than two-dimensional ultrasonography (χ2 =3.91,P<0.05). Conclusions Three-dimensional ultrasonography imaging could provide more abundant information. It has great value in understanding the spatial relations between hilar cholangiocarcinoma and intrahepatic bile duct tree, definituding classification of hilar cholangiocarcinoma.