医药学论文：螺旋CT对诊断乏特氏壶腹癌的应用

【关键词】 乏特氏壶腹癌

　　摘 要：目的: 探讨螺旋CT在诊断乏特氏壶腹癌的应用价值。方法：回顾性分析了26例经手术病理证实的乏特氏壶腹癌的螺旋ＣＴ表现，均服开水做对比剂充盈肠管，病变局部采用薄层增强扫描，17例辅以图像后处理技术。结果：26例患者均有不同程度的胆道web/Info/softb/index.htm' target=_blank>系统低位梗阻，25例CT图像能明确壶腹部肿块，能清晰显示肿瘤的部位，大小以及周围组织结构的关系。结论：壶腹部肿块是乏特氏壶腹癌的CT直接征象，应用螺旋CT薄层增强扫描与图像后处理技术相结合对壶腹癌的诊断和鉴别诊断是可靠而有效的方法, 并对其手术治疗提供重要的指导作用。

　　关键词： 乏特氏壶腹癌; 体层摄影术； Ｘ线计算机

　　Spiral CT in Diagnosis and Application of Carcinoma of Vaters Ampulla

　　Abstract: Objective:To evaluate CT diagnostic value of carcinoma of vaters ampulla.Methods:SCT findings of 26 cases of Vaters ampullary carcinoma proved surgically and pathologically were analyzed retrospectively in taking water to make the contrast fulling intestine and the focus were scaned by the thin-slice enhancement partially,in which 17 examples were auxiliary by image post-processing technology.Result: The 26 examples patients all have the varying degree the biliary duct system low position obstruction.In which 25 examples CT image can be clear about the mass in the region of vaters ampulla,and clearly display the spot, the size as well as periphery the organizational structure relations of the carcinoma. Conclusion:The direct CT signs of carcinoma of vaters ampulla is finding mass in the region of Vaters ampulla,and it is a reliable and effective method to diagnosis and the distinction diagnosis of ampullary carcinoma with the combination of the spiral CT scanning of thin-slice and image post-processing technology,and it offers important guidance role to its operation treatment.

　　Key words： Carcinoma of Vaters ampulla； Tomography； X-ray computed

　　乏特氏壶腹是胆总管、胰管末端连接十二指肠乳头交汇区的一个特定解剖部位。壶腹部癌是引起阻塞性黄疸的重要原因之一，本文收集了2001年7月至2005年9月本院26例均经CT扫描并手术、病理证实的壶腹癌, 进行回顾性分析其CT表现, 以期提高对本病的诊治, 报告如下:

　　1 材料与方法

　　1.1 临床bbs/index.htm' target=_blank>资料：本组26例,男15例,女11例。年龄41～72岁，平均58岁。临床表现：渐进性黄疸26例(其中无痛性黄疸17例,上腹不适伴黄疸9例)。入院后行CT检查，并经手术病理确诊为壶腹癌或壶腹周围癌。19例外科采用了胰十二指肠切除术，肿瘤局部切除术4例，3例采用单纯胆肠内引流术姑息手术方法。

　　1.2 检查方法：使用GE公司的Hispeed NX/i螺旋CT机进行螺旋扫描，距阵512×512，扫描时间为1ｓ，全部病例均采用平扫和增强，常规扫描层厚10.0mm，局部用3～5.0mm，图像后处理重建用2.0mm，(包括最小密度投影、曲面重建技术，和多平面重建技术)。扫描前5min口服清水500ml，使用非离子型对比剂(优维显80～100ml,1.5ml/kg)行静脉团注动态增强扫描，注射速率3.0ml/s，注药后25s、60s分别行动脉期、门静脉期扫描。