切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2014, Vol. 03 ›› Issue (01) : 33 -36. doi: 10.3877/cma.j.issn.2095-3232.2014.01.009

所属专题： 文献；

临床研究

超声造影在评估肝门部胆管癌浸润范围中的临床价值
郭光辉1, 任杰1, 郑荣琴1, 张婷1, 吴涛1, 张曼1, 许尔蛟1,†()   
  1. 1. 510630　广州，中山大学附属第三医院超声科
  • 收稿日期:2013-11-10 出版日期:2014-02-10
  • 通信作者: 许尔蛟
  • 基金资助:
    广东省医学科研基金(B2013137); 广东省科技计划项目(2009B060700026)

Clinical value of contrast-enhanced ultrasound in evaluating the invasive area of hilar cholangiocarcinoma

Guanghui Guo1, Jie Ren1, Rongqin Zheng1, Ting Zhang1, Tao Wu1, Man Zhang1, Erjiao Xu1,†()   

  1. 1. Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2013-11-10 Published:2014-02-10
  • Corresponding author: Erjiao Xu
  • About author:
    Corresponding author: Xu Erjiao, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

郭光辉, 任杰, 郑荣琴, 张婷, 吴涛, 张曼, 许尔蛟. 超声造影在评估肝门部胆管癌浸润范围中的临床价值[J]. 中华肝脏外科手术学电子杂志, 2014, 03(01): 33-36.

Guanghui Guo, Jie Ren, Rongqin Zheng, Ting Zhang, Tao Wu, Man Zhang, Erjiao Xu. Clinical value of contrast-enhanced ultrasound in evaluating the invasive area of hilar cholangiocarcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2014, 03(01): 33-36.

目的

探讨超声造影在评估肝门部胆管癌浸润范围中的临床价值。

方法

回顾性分析2005年1月至2013年3月在中山大学附属第三医院超声科行常规超声检查和超声造影,并经增强CT、MRI或手术病理学检查确诊的103例肝门部胆管癌患者临床资料。其中男70例，女33例；平均年龄（59±13）岁。所有患者均签署知情同意书，符合医学伦理学规定。患者均接受常规超声检查和超声造影，观察两种检查方法对肝门部胆管癌浸润范围显示情况；以增强CT、MRI或手术病理学检查为金标准，分别计算两种检查方法对肝门部胆管癌浸润范围的诊断符合率。两种检查方法对肝门部胆管癌浸润范围的诊断符合率比较采用χ2检验。

结果

常规超声检查中，肿瘤边界显示不清28例，肿瘤边界显示清及欠清75例，其中33%（25/75）患者肿瘤浸润范围为胆管腔内型，67%（50/75）为胆管腔内外型。超声造影动脉期, 51.4%（53/103）患者肿瘤呈高增强, 28.2%（29/103）呈等增强，20.4%（21/103）呈低增强；静脉期，100%（103/103）患者肿瘤呈低增强。16.5%（17/103）患者肿瘤浸润范围为胆管腔内型, 83.5%（86/103）为胆管腔内外型。常规超声检查对肝门部胆管癌浸润范围的诊断符合率为59.2%（61/103），超声造影为99.0%（102/103），超声造影对肝门部胆管癌浸润范围的诊断符合率明显高于常规超声检查（χ2=17.611, P<0.05）。

结论

与常规超声检查相比，超声造影能更准确地评估肝门部胆管癌浸润范围。

关键词: 超声检查, 超声检查，介入性, 胆管肿瘤, 肿瘤侵润
Objective

To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in evaluating the invasive area of hilar cholangiocarcinoma.

Methods

Clinical data of 103 patients with hilar cholangiocarcinoma who received conventional ultrasound and CEUS examination in Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University from January 2005 to March 2013 were analyzed retrospectively. The patients were confirmed by contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI) or surgical pathological examination. There were 70 males and 33 females with mean age of (59±13) years old. The informed consents of all patients were obtained and the ethical committee approval was received. The patients received conventional ultrasound and CEUS examination both. The display of invasive area of hilar cholangiocarcinoma by two methods was observed. The contrast-enhanced CT, MRI or surgical pathological examination were regarded as the gold standards. The diagnostic accordance rates of invasive area of hilar cholangiocarcinoma by two methods were calculated and compared using Chi-square test.

Results

For conventional ultrasound, 28 cases were with ill-defined tumor borders and 75 cases were with well-defined or poorly defined tumor borders, in which 33% (25/75) of the tumor invasive areas were intraductal, 67% (50/75) were intraductal and extraductal. In arterial phase of CEUS, tumors in 51.4% (53/103) of patients were displayed hyper-enhanced, 28.2% (29/103) were homo-enhanced, and 20.4% (21/103) were hypo-enhanced. In venous phase, tumors in 100% (103/103) of patients were displayed hypo-enhanced. For CEUS, 16.5% (17/103) of the tumor invasive areas were intraductal, 83.5% (86/103) were intraductal and extraductal. The diagnostic accordance rate was 59.2% (61/103) by conventional ultrasound and was 99.0% (102/103) by CEUS. The diagnostic accordance rate of CEUS was significantly higher than that of conventional ultrasound (χ2=17.611, P<0.05).

Conclusion

Compared with conventional ultrasound, CEUS can evaluate the invasive area of hilar cholangiocarcinoma more accurately.

Key words: Ultrasonography, Ultrasonography, interventional, Bile duct neoplasms, Neoplasm invasiveness
[1]
Welzel TM,McGlynn KA,Hsing AW, et al. Impact of classifcation of hilar cholangiocarcinomas (Klatskin tumors) on the incidence of intra- and extrahepatic cholangiocarcinoma in the United States[J]. J Natl Cancer Inst, 2006, 98(12): 873-875.
[2]
Bold RJ,Goodnight JE Jr. Hilar cholangiocarcinoma: surgical and endoscopic approaches[J]. Surg Clin North Am, 2004, 84(2): 525-542.
[3]
Clary B,Jarnigan W,Pitt H, et al. Hilar cholangiocarcinoma[J]. J Gastrointest Surg, 2004, 8(3): 298-302.
[4]
Burke EC,Jarnagin WR,Hochwald SN, et al. Hilar patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system[J]. Ann Surg, 1998, 228(3): 385-394.
[5]
Claudon M,Cosgrove D,Albrecht T, et al. Guidelines and good clinical practice recommendations for contrast enhanced altrasound (CEUS): update 2008[J]. Ultraschall Med, 2008, 29(1): 28-44.
[6]
Ito F,Cho CS,Rikkers LF, et al. Hilar cholangiocarcinoma: current management[J]. Ann Surg, 2009, 250(2): 210-218.
[7]
Vilgrain V. Staging cholangiocarcinoma by imaging studies[J]. HPB, 2008, 10(2): 106-109.
[8]
Foley WD,Quiroz FA. The role of sonography in imaging of the biliary tract[J]. Ultrasound Q, 2007, 23(2): 123-135.
[9]
周宁新，陈军周．肝门部胆管癌外科治疗现状与评价[J]．中华外科杂志，2009, 47(15): 1127-1129.
[10]
Jang JY,Kim SW,Park DJ, et a1. Actual long-term outcome of extrahepatic bile duct cancer after surgical resection[J]. Ann Surg, 2005, 241(1): 77-84.
[11]
Manfredi R,Masselli G,Maresca G, et al. MR imaging and MRCP of hilar cholangiocarcinoma[J]. Abdom Imaging, 2003, 28(3): 319-325.
[12]
Choi JY,Kim MJ,Lee JM, et al. Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography[J]. AJR Am J Roentgenol, 2008, 191(5): 1448-1457.
[13]
Neumaier CE,Bertolotto M,Perrone R, et al. Staging of hilar cholangiocarcinoma with ultrasound[J]. J Clin Ultrasound, 1995, 23(3): 173-178.
[14]
吴涛，许尔蛟，郑荣琴，等．肝门部胆管癌超声造影与增强MRI增强模式的对比研究[J/CD]．中华医学超声杂志：电子版，2012, 9(3): 211-215.
[15]
Bismuth H,Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver[J]. Surg Gynecol Obstet, 1975, 140(2): 170-178.
[16]
Wilson SR,Burns PN. An algorithm for the diagnosis of focal liver masses using microbubble contrast-enhanced pulse-inversion sonography[J]. AJR Am J Roentgenol, 2006, 186(5): 1401-1412.
[17]
Xu HX,Chen LD,Xie XY, et al. Enhancement pattern of hilar cholangiocarcinoma: contrast-enhanced ultrasound versus contrast-enhanced computed tomography[J]. Eur J Radiol, 2010, 75(2): 197-202.
[18]
Bauditz J,Schade T,Wermke W. Sonographic diagnosis of hilar cholangiocarcinomas by the use of contrast agents[J]. Ultraschall Med, 2007, 28(2): 161-167.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[3] 朱连华, 费翔, 韩鹏, 姜波, 李楠, 罗渝昆. 高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 904-910.
[4] 张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 945-950.
[5] 陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 974-978.
[6] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[7] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[8] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 844-848.
[9] 张丽丽, 陈莉, 余美琴, 聂小艳, 王婧玲, 刘婷. PDCA循环法在超声浅表器官亚专科建设中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 717-721.
[10] 罗刚, 泮思林, 陈涛涛, 许茜, 纪志娴, 王思宝, 孙玲玉. 超声心动图在胎儿心脏介入治疗室间隔完整的肺动脉闭锁中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 605-609.
[11] 黄佳, 石华, 张玉国, 胡佳琪, 陈茜. 胎儿左头臂静脉正常与异常超声图像特征及其临床意义[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 610-617.
[12] 袁泽, 庄丽. 超声检测胎儿脐动脉和大脑中动脉血流对胎儿宫内窘迫的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 618-621.
[13] 蒋佳纯, 王晓冰, 陈培荣, 许世豪. 血清学指标联合常规超声及超声造影评分诊断原发性干燥综合征的临床价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 622-630.
[14] 武壮壮, 张晓娟, 史泽洪, 史瑶, 原韶玲. 超声联合乳腺X线摄影及PR、Her-2预测高级别与中低级别乳腺导管原位癌的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 631-635.
[15] 张生军, 赵阿静, 李守博, 郝祥宏, 刘敏丽. 高糖通过HGF/c-met通路促进结直肠癌侵袭和迁移的实验研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 21-24.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号