目的 探讨CT在诊断Bismuth-Corlette Ⅳ型肝门部胆管癌及术前可切除性评估中的价值。方法 回顾性分析2017-02至2021-05经病理证实的57例肝门部胆管癌患者的CT资料,评价CT诊断Bismuth-Corlette Ⅳ型肝门部胆管癌的准确率。分析其中31例Ⅳ型肝门部胆管癌的胆管受累范围、肝叶萎缩、血管侵犯、淋巴结转移情况,探讨CT诊断与手术及病理结果的一致性。结果 CT诊断Bismuth-Corlette Ⅳ型肝门部胆管癌的准确率为89.5%;CT评估胆管受累范围、肝叶萎缩、肝动脉侵犯、门静脉侵犯及淋巴结转移的敏感度分别为70.0%、100.0%、75.0%、83.3% 和69.2%,特异度为90.5%、100.0%、91.3%、94.7% 和83.3%,准确率为83.9%、100.0%、87.1%、90.3% 和77.4%,与手术一致性分析的Kappa值分别为0.62、1、0.66、0.79和0.53。CT评估Ⅳ型肝门部胆管癌可切除性的Kappa值为0.68,敏感度为85.7%,特异度为82.3%,准确率为83.9%。结论 CT是诊断Bismuth-Corlette Ⅳ型肝门部胆管癌和评估其可切除性的重要手段。
Abstract
Objective To explore the value of CT in the diagnosis and presurgical assessment of resectability of Bismuth-Corlette type-Ⅳ hilar cholangiocarcinoma (HCCA). Methods Fifty-seven patients with pathologically confirmed HCCA from February 2017 to May 2021 were retrospectively analyzed to evaluate the accuracy of CT in the diagnosis of Bismuth-Corlette type-Ⅳ HCCA. Extent of bile duct involvement, hepatic lobe atrophy, vascular invasion and lymph node metastasis in 31 patients with Bismuth-Corlette type-Ⅳ HCCA were analyzed to explore the consistency between CT diagnosis and surgical and pathological results. Results The accuracy of CT in the diagnosis of Bismuth-Corlette type-Ⅳ HCCA was 89.5%. The sensitivity of CT in evaluating the range of bile duct involvement, hepatic lobe atrophy, hepatic artery invasion, portal vein invasion and lymph node metastasis was 70.0%, 100.0%, 75.0%, 83.3% and 69.2%, respectively. The specificity was 90.5%, 100.0%, 91.3%, 94.7% and 83.3%, respectively. The accuracy was 83.9%, 100.0%, 87.1%, 90.3% and 77.4%, respectively. The Kappa value of consistency analysis with surgery was 0.62, 1, 0.66, 0.79 and 0.53, respectively. The Kappa value of CT in preoperative evaluation of resectability of Bismuth-Corlette type-Ⅳ HCCA was 0.68, with a sensitivity of 85.7%, specificity of 82.3% and accuracy of 83.9%. Conclusions CT plays an important role in the diagnosis and presurgical assessment of resectability of Bismuth-Corlette type-Ⅳ HCCA.
关键词
肝门部胆管癌 /
Bismuth-Corlette分型 /
X线计算机体层摄影 /
术前评估 /
可切除性
Key words
hilar cholangiocarcinoma /
Bismuth-Corlettetyping /
X-ray computed tomography /
presurgical evaluation /
resectability
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