囊型肝包虫病的多排螺旋CT诊断及术前影像检查的术前指导价值
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摘要
目的探讨多排螺旋CT(multi-detectorhelical CT,MDCT)对囊型肝包虫病诊断价值及对肝内管道受累情况的术前指导价值。方法 68例囊型肝包虫病患者均经外膜内外囊完整摘除术治疗及病理证实,且术前均行MDCT多期扫描,应用三维重建技术观察病灶与血管、胆管的空间关系,综合手术所见与影像特征进行对照。结果 MDCT在68例中共检出112个病灶;血管重建显示与第一/二肝门关系密切病灶25个,受累肝动脉37支,肝静脉62支,门静脉41支,下腔静脉16支,对照采用Kappa一致性检验,结果与手术所见具有较高的一致性;胆管受累共29例,与手术实际情况一致。结论 MDCT检查能诊断囊型肝包虫病,并能很好地显示肝包虫血管及胆管受累的影像学特征,为手术提供可靠的影像学依据及评估。
Objective To investigate the diagnostic value of multi-detector helical CT(MDCT) in hepatic cystic echinococcosis(HCD) and the applicability of MDCT to preoperative evaluation of biliary ducts affected by HCD.Methods Sixty-eight cases of HCD confirmed by radical surgery were collected in this study.Each of the cases underwent multi-phase scanning with MDCT,and 3D image reconstruction of hepatic vessels was performed.Results The sixty-eight cases of liver hydatid cysts had a total of 112 lesions,all of which were detected by MDCT before surgery.Twenty-five lesions were closely related to the first porta hepatis or second porta hepatis.Thirty-seven hepatic arteries,sixty-two hepatic veins,forty-one portal veins,and sixteen inferior vena cava and bile ducts(29 cases) were involved.The result was consistent with the surgical findings by Kappa consistency test.Conclusions MDCT examination can diagnose HCD and the intrahepatic vessels involved can be clearly showed by 3D image reconstruction,providing reliable imaging evaluation and basis for operation.
Objective To investigate the diagnostic value of multi-detector helical CT(MDCT) in hepatic cystic echinococcosis(HCD) and the applicability of MDCT to preoperative evaluation of biliary ducts affected by HCD.Methods Sixty-eight cases of HCD confirmed by radical surgery were collected in this study.Each of the cases underwent multi-phase scanning with MDCT,and 3D image reconstruction of hepatic vessels was performed.Results The sixty-eight cases of liver hydatid cysts had a total of 112 lesions,all of which were detected by MDCT before surgery.Twenty-five lesions were closely related to the first porta hepatis or second porta hepatis.Thirty-seven hepatic arteries,sixty-two hepatic veins,forty-one portal veins,and sixteen inferior vena cava and bile ducts(29 cases) were involved.The result was consistent with the surgical findings by Kappa consistency test.Conclusions MDCT examination can diagnose HCD and the intrahepatic vessels involved can be clearly showed by 3D image reconstruction,providing reliable imaging evaluation and basis for operation.
引文
[1]彭赟杰,邵英梅.肝囊型包虫病破入胆道的诊疗现状[J].中国普通外科杂志,2009,18(8):861-863.
[2]范维鹏,杨庆,赵明芳,等.多层螺旋CT(MSCT)三维重建技术在肝外胆管结石疾病的应用[J].临床和实验医学杂志,2006,5(5):582-583.
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[4]中国医师协会外科医师分会包虫病外科专业委员会.肝两型包虫病诊断与治疗专家共识(2015版)[J].中华消化外科杂志,2015,4(14):253-264.
[5]柴君杰,孟贺巴特,叶尔江·苏里唐,等.肝囊型包虫病药物治疗中B超影像动态观察及分类建议[J].中国寄生虫学与寄生虫病杂志,2013,21(3):134-138.
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[11]彭新宇,李建辉,赵瑾,等.肝细粒棘球蚴周围纤维囊壁钙化分布及意义[J].中国人兽共患病学报,2006,22(9):825-827.
[12]姚昆琛,陶建华,边雪峰,等.MSCT对肝包虫囊肿及并发症的诊断价值[J].中国中西医结合影像学杂志,2013,11(4):363-365.
[13]袁克文,党政,遆振宇,等.25例肝包虫囊肿破入胆道的诊治体会[J].临床肝胆病杂志,2012,28(7):509-512.
[14]吐尔干艾力,邵英梅,赵晋明,等.肝囊型包虫病胆道并发症284例的诊治分析[J].中华肝胆外科杂志,2011,17(2):104-109.
[15]王健,蒋奕,赵艳萍,等.多层螺旋CT对肝包虫病累及血管或胆管的术前评价[J].中华放射学杂志,2010,44(4):397-400.
[16]Ward S T,Jewkes A J,Jones B G,et al.The sensitivity of needle core biopsyincombination with other investigations for the diagnosis of phyllodestumours of the breast[J].International Journal of Surgery,2012,10(9):527-531.
[17]马志刚,彭心宇.囊型肝包虫的现代外科治疗[J].现代生物医学进展,2009,9(24):4783-4785.
[18]姜超,王海久.CT三维重建在肝胆外科的应用现状[J].临床肝胆病杂志,2017,33(2):389-393.
[19]Endo I,Shimada,Sugita M,et al.Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma[J].Surgery,2007,142(5):666-675.
[20]唐敏,杨尚文,马一鸣,等.64排螺旋CT扫描数据基础上的门静脉和肝静脉三维解读及其解剖变异分析[J].中国临床医学影像杂志,2013,24(5):338-340.
[2]范维鹏,杨庆,赵明芳,等.多层螺旋CT(MSCT)三维重建技术在肝外胆管结石疾病的应用[J].临床和实验医学杂志,2006,5(5):582-583.
[3]温浩,栾梅香,杨文光,等.肝包虫病的标准化分型及临床意义探讨[J].新疆医科大学学报,2002,25(2):129-130.
[4]中国医师协会外科医师分会包虫病外科专业委员会.肝两型包虫病诊断与治疗专家共识(2015版)[J].中华消化外科杂志,2015,4(14):253-264.
[5]柴君杰,孟贺巴特,叶尔江·苏里唐,等.肝囊型包虫病药物治疗中B超影像动态观察及分类建议[J].中国寄生虫学与寄生虫病杂志,2013,21(3):134-138.
[6]朱洪伟,安丽娅.新疆精河地区肝包虫病的超声与CT诊断及分型[J].新疆医学,2013,43(10):65-68.
[7]张怀孝,樊海宁.肝囊性包虫病的临床诊断与治疗现状[J].中华地方病学杂志,2015,3(44):309-311.
[8]朱明生,桂东川,赵峰,等.91例肝包虫囊肿退行性变的CT诊断分析[J].中国人兽共患病学报,2009,25(2):200-201.
[9]吴向未,彭心宇,张示杰,等.肝脾棘球蚴囊周围纤维性囊壁形成机制的差异及临床意义[J].中国寄生虫学与寄生虫病杂志,2004,22(1):1-4.
[10]赵阳阳,张示杰,车小双,等.肝囊性包虫病的CT表现与临床病理改变的相关性研究[J].实用医学杂志,2013,29(13):2107-2110.
[11]彭新宇,李建辉,赵瑾,等.肝细粒棘球蚴周围纤维囊壁钙化分布及意义[J].中国人兽共患病学报,2006,22(9):825-827.
[12]姚昆琛,陶建华,边雪峰,等.MSCT对肝包虫囊肿及并发症的诊断价值[J].中国中西医结合影像学杂志,2013,11(4):363-365.
[13]袁克文,党政,遆振宇,等.25例肝包虫囊肿破入胆道的诊治体会[J].临床肝胆病杂志,2012,28(7):509-512.
[14]吐尔干艾力,邵英梅,赵晋明,等.肝囊型包虫病胆道并发症284例的诊治分析[J].中华肝胆外科杂志,2011,17(2):104-109.
[15]王健,蒋奕,赵艳萍,等.多层螺旋CT对肝包虫病累及血管或胆管的术前评价[J].中华放射学杂志,2010,44(4):397-400.
[16]Ward S T,Jewkes A J,Jones B G,et al.The sensitivity of needle core biopsyincombination with other investigations for the diagnosis of phyllodestumours of the breast[J].International Journal of Surgery,2012,10(9):527-531.
[17]马志刚,彭心宇.囊型肝包虫的现代外科治疗[J].现代生物医学进展,2009,9(24):4783-4785.
[18]姜超,王海久.CT三维重建在肝胆外科的应用现状[J].临床肝胆病杂志,2017,33(2):389-393.
[19]Endo I,Shimada,Sugita M,et al.Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma[J].Surgery,2007,142(5):666-675.
[20]唐敏,杨尚文,马一鸣,等.64排螺旋CT扫描数据基础上的门静脉和肝静脉三维解读及其解剖变异分析[J].中国临床医学影像杂志,2013,24(5):338-340.