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目的探讨多层螺旋CT在壶腹周围癌中的诊断价值。材料和方法回顾性分析经病理证实的76例壶腹周围癌的CT表现。结果发现胆道梗阻65例,位于胰上段20例,胰腺段18例,壶腹段27例。梗阻面管腔形态分为截断型30例,漏斗型或鸟嘴型20例,鼠尾型15例。“双管征”出现60例,其中胰胆管相交19例,胰胆管分离25例,梗阻近端胰管未扩张16例。CT明确检出肿物63例,CT表现为异常10例,CT未发现病变3例。检出的63例病灶全部有不同程度的强化,根据来源不同,强化方式有所区别。手术病理证实淋巴结转移29例。结论 CT可以准确检出壶腹周围癌所致胆道梗阻。沿着梗阻段结合增强扫描,CT可检出肿瘤。多期增强扫描对于鉴别肿瘤起源有帮助。多层螺旋CT在壶腹周围癌的诊断上有实用价值,但存在一定的局限性,需要综合应用各种检查手段,以提高诊断准确性。
Objective To investigate the diagnostic value of multislice spiral CT in periampullary carcinoma. Materials and Methods CT findings of 76 cases of periampullary carcinoma confirmed by pathology were retrospectively analyzed. The results showed that 65 cases of biliary obstruction, located in the upper part of the pancreas in 20 cases, 18 cases of pancreatic segment, 27 cases of ampulla. Obstruction surface lumen morphology was divided into 30 cases of truncated type, funnel-type or beak-type 20 cases, rat tail type in 15 cases. There were 60 cases of “double-tube sign”, of which 19 cases involved pancreaticobiliary ducts, 25 cases of pancreaticobiliary ducts, and 16 cases of obstructed proximal pancreatic ducts. CT clearly detected 63 cases of tumors, CT showed abnormalities in 10 cases, CT found no lesions in 3 cases. All the 63 lesions detected had different degrees of intensification. According to different sources, the methods for strengthening were different. Pathologically confirmed 29 cases of lymph node metastasis. Conclusion CT can accurately detect biliary obstruction caused by periampullary cancer. Along the obstructed segment combined with enhanced scan, CT can detect the tumor. Multiphase enhanced scans are helpful in identifying the origin of the tumor. Multi-slice spiral CT has practical value in the diagnosis of periampullary carcinoma, but it has some limitations and requires comprehensive application of various inspection methods to improve the diagnostic accuracy.