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。

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。

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）。

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。

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

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.

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).

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