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1、·340·中國(guó)臨床醫(yī)學(xué)影像雜志2014年第25卷第5期JChinClinMedImaging，2014，Vo1．25，No．5膽管癌栓經(jīng)皮肝穿刺膽管造影術(shù)的診斷價(jià)值孫巍，溫鋒，盧再嗚，郭啟勇(中國(guó)醫(yī)科大學(xué)附屬盛京醫(yī)院放射科，遼寧沈陽(yáng)110004)[摘要】目的：分析膽管癌栓經(jīng)皮肝穿刺膽管造影術(shù)(Percutaneoustranshepaticcholangiography，PTC)的影像特點(diǎn)，以提高膽管癌栓的診斷水平。資料與方法：回顧性分析27例經(jīng)病理或臨床證實(shí)為膽管癌栓的PTC圖像特點(diǎn)?；颊吣挲g(49．81~7
2、．27)歲。27例患者均在超聲或DSA引導(dǎo)下選擇單側(cè)或雙側(cè)穿刺人路行PTC，留置內(nèi)引流管或外引流管，引流3～5d后復(fù)查PTC以觀察影像變化情況。結(jié)果：27例膽管癌栓均于膽管腔內(nèi)可見(jiàn)充盈缺損影，26例充盈缺損及相應(yīng)水平膽管呈“膨脹性”改變。24例癌栓近端膽管呈軟藤樣擴(kuò)張，3例呈枯樹(shù)枝樣改變，癌栓遠(yuǎn)端膽管均無(wú)擴(kuò)張。9例充盈缺損的輪廓完全顯示，其余18例部分顯示。21例引流前后所見(jiàn)充盈缺損范圍基本一致，6例引流后充盈缺損范圍較前縮小。根據(jù)其累及范圍分為3型：I型2例，Ⅱ型22例，Ⅲ型3例。結(jié)論：膽管癌栓有特異性的PT
3、C表現(xiàn)，PTC對(duì)膽管癌栓的診斷有重要價(jià)值。【關(guān)鍵詞】膽管腫瘤；膽管造影術(shù)【中圖分類(lèi)號(hào)】R735．8；R814．43【文獻(xiàn)標(biāo)識(shí)碼】A【文章編號(hào)】1008—1062(2014)05—0340—04DiagnosticvalueofpercutaneoustranshepaticcholangiOgraphyonbileducttumorthrombusSUNWei．WENFeng,LUZai—ming,GUOQi-yong(DepartmentofRadiology,ShengfingHospitalofChina
4、MedicalUniversity,Shenyang110004，China)Abstract：0bjective：Toanalyzepercutaneoustranshepaticcholangiography(PTC)imagingfeaturesofbileductcarcinomathrombus．MaterialsandMethods：PTCimagesof27patients(themeanagewas49．81±7．27yearsold)withhistologicallyprovedtohave
5、bileductcarcinomathrombuswerereviewedretrospectively．A1l27PTCwereperformedundertheguidanceofultrasoundorDSAbyselectiveunilateralorbilateralintrahepaticbileductpuncture．InternalorexternaldrainagewaskeptuntilrepeatedPTCwasperformedafter3-5dtoobservetheimagingc
6、hanges．Results：Fillingdefectsinbileductswereseenina1l27patients．Thefillingdefectsandinvolvedbileductsshowedexpandingappearancein26cases．Proximalbileductstotheinvolvedpartsweredilatedlikesoftcanesin24casesandfallenbranchesin3cases．Distalbileductsshowednodi-la
7、tioninanyofthecase．Thecontoursoffillingdefectswereclearlyshownin9casesandpartiallyshownin18cases．Twenty—onecasesshowedconstantfillingdefectswhile6caseshadshrunkenfillingdefectsafterdrainage．Threetypesweredefinedaccordingtotheinvolvedrange：TypeI，2case；TypeⅡ，2
8、2cases；TypellI，3cases．Conclusion：BileducttumorthrombushavesometypicalPTCimagingfeatures，PTCisusefulindetectinganddiagnosingbileducttumorthrombus．Keywords：Bileductneoplasms；Cholangiography膽管癌栓發(fā)生率
