十二指肠降段腺癌CT特点及误诊分析
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摘要
目的回顾性分析十二指肠降段腺癌的CT诊断及误诊,总结十二指肠腺癌的临床、CT表现及误诊原因。方法对2017年1—12月在淮安市第一人民医院就诊的经病理检查证实为十二指肠腺癌的14例(误诊4例)患者进行回顾性阅片分析,结合手术观察及病理,找出误诊原因。结果 14例患者中误诊为胰头恶性肿瘤2例、良性病变1例,胆总管恶性病变1例。误诊病例中肿块型3例,缩窄型1例。结论医师应提高对十二指肠恶性疾病的警觉,出现典型征象时应结合多种表现综合评定,患者提前进行充分的肠道准备,以提高CT诊断的准确率。
Objective To retrospectively analyze the CT diagnosis and misdiagnosis of duodenal descending adenocarcinoma and to summarize the clinical manifestations and the causes of misdiagnosis of duodenal adenocarcinoma. Methods A retrospective analysis of 14 cases of duodenal adenocarcinoma( 4 cases misdiagnosed) confirmed by pathology in Huai'an First People's Hospital from January to December 2017 was done. Combined with surgical observation and pathology,the causes of misdiagnosis were identified. Results Among the 14 cases,2 cases were misdiagnosed as pancreatic malignant tumors,1 case as benign lesions and 1 case as common bile duct malignant lesions. Among the misdiagnosed cases,there were 3 cases of mass type and 1 case of constriction type. Conclusion In order to improve the accuracy of CT diagnosis,doctors should be more alert to malignant duodenal diseases. It is necessary to evaluate the typical symptoms in combination with multiple manifestations,and the patients should be well prepared for intestinal tract in advance.
Objective To retrospectively analyze the CT diagnosis and misdiagnosis of duodenal descending adenocarcinoma and to summarize the clinical manifestations and the causes of misdiagnosis of duodenal adenocarcinoma. Methods A retrospective analysis of 14 cases of duodenal adenocarcinoma( 4 cases misdiagnosed) confirmed by pathology in Huai'an First People's Hospital from January to December 2017 was done. Combined with surgical observation and pathology,the causes of misdiagnosis were identified. Results Among the 14 cases,2 cases were misdiagnosed as pancreatic malignant tumors,1 case as benign lesions and 1 case as common bile duct malignant lesions. Among the misdiagnosed cases,there were 3 cases of mass type and 1 case of constriction type. Conclusion In order to improve the accuracy of CT diagnosis,doctors should be more alert to malignant duodenal diseases. It is necessary to evaluate the typical symptoms in combination with multiple manifestations,and the patients should be well prepared for intestinal tract in advance.
引文
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[2] Albores-Saavedra J,Schwartz AM,Batich K,et al. Cancers of theampulla of vater:Demographics,morphology,and survival basedon 5,625 cases from the SEER program[J]. J Surg Oncol,2010,100(7):598-605.
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[5]张思森,陈雷,冷希圣,等.十二指肠腺癌89例临床分析[J].中华普通外科杂志,2011,26(7):543-545.
[6]杜滂,秦越,崔光彬,等. MRCP及LAVA联合应用在壶腹周围癌鉴别诊断中的价值[J].现代肿瘤医学,2010,18(4):736-740.
[7] Santoro E,Sacchi M,Scutari F,et al. Primary adenocarcinoma ofthe duodenum:Treatment and survival in 89 patients[J]. Hepato-gastroenterology,1997,44(16):1157-1163.
[8]葛绪波.十二指肠腺癌的X线和CT诊断对比研究[J].中国CT和MRI杂志,2014,12(3):84-86.
[9]李果珍.临床CT诊断学[M].北京:中国科学技术出版社,1994:493-494.
[10] Farah MC,Jafri SZ,Schwab RE,et al. Duodenal neoplasms:Roleof CT[J]. Radiology,1987,162(3):839-843.
[11] Dudiak KM,Johnson CD,Stephens DH. Primary tumors of thesmall intestine:CT evaluation[J]. AJR Am J Roentgenol,1989,152(5):995-998.
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[13]宋彬,龚怡,张蓓,等.十二指肠间质瘤的螺旋CT表现[J].中国医学计算机成像杂志,2008,14(5):425-428.
[14] Sandrasegaran K,Rajesh A,Rushing DA,et al. Gastrointestinalstromal tumors:CT and MRI findings[J]. Eur Radiol,2005,15(7):1407-1414.
[15]陈晓煜,印隆林,谢欢,等. MRI联合序列检查在壶腹周围癌鉴别诊断中的价值[J].实用放射学杂志,2017,33(6):561-566.
[16]陈军法,王卫霞,王小鹏,等. MRI 3D-VIBE序列联合MRCP在胰胆管十二指肠连接区癌鉴别诊断中的价值[J].四川大学学报(医学版),2009,40(6):1110-1114.
[17] Kim JY,Lee JM,Han JK,et al. Contrast-enhanced MRI combinedwith MR cholangiopancreatography for the evaluation of patientswith biliary strictures:Differentiation of malignant from benign bileduct strictures[J]. J Magn Reson Imaging,2007,26(2):304-312.
[18]郝粉娥,牛广明,韩晓东,等. MRCP结合薄层T2WI对壶腹周围病变的诊断价值[J].实用放射学杂志,2008,24(11):1492-1495.
[19]孙娜娜,刘希胜,徐青,等. MR平扫及冠状面LAVA技术在低位胆管梗阻中的诊断价值[J].临床放射学杂志,2012,31(3):356-360.
[20]李绍东,徐凯,张秀莉,等.高场MRI动态增强联合MRCP在肝外癌性梗阻性黄疸中的应用[J].中国医学计算机成像杂志,2011,17(5):433-436.
[21]葛相栓,李建平,王慧超,等.十二指肠球部恶性肿瘤14例误诊分析[J].临床消化病杂志,2016,28(5):307-309.
[2] Albores-Saavedra J,Schwartz AM,Batich K,et al. Cancers of theampulla of vater:Demographics,morphology,and survival basedon 5,625 cases from the SEER program[J]. J Surg Oncol,2010,100(7):598-605.
[3] Yan JQ,Peng CH,Yang WP,et al. Surgical management ofbenign duodenal tumours[J]. ANZ J Surg,2010,80(7/8):526-530.
[4]夏瑞明,章士正,张汉良.十二指肠恶性肿瘤的CT诊断与鉴别诊断[J].实用放射学杂志,2005,21(1):48-50.
[5]张思森,陈雷,冷希圣,等.十二指肠腺癌89例临床分析[J].中华普通外科杂志,2011,26(7):543-545.
[6]杜滂,秦越,崔光彬,等. MRCP及LAVA联合应用在壶腹周围癌鉴别诊断中的价值[J].现代肿瘤医学,2010,18(4):736-740.
[7] Santoro E,Sacchi M,Scutari F,et al. Primary adenocarcinoma ofthe duodenum:Treatment and survival in 89 patients[J]. Hepato-gastroenterology,1997,44(16):1157-1163.
[8]葛绪波.十二指肠腺癌的X线和CT诊断对比研究[J].中国CT和MRI杂志,2014,12(3):84-86.
[9]李果珍.临床CT诊断学[M].北京:中国科学技术出版社,1994:493-494.
[10] Farah MC,Jafri SZ,Schwab RE,et al. Duodenal neoplasms:Roleof CT[J]. Radiology,1987,162(3):839-843.
[11] Dudiak KM,Johnson CD,Stephens DH. Primary tumors of thesmall intestine:CT evaluation[J]. AJR Am J Roentgenol,1989,152(5):995-998.
[12]耿进朝,张俊英,周玉荣,等.原发性十二指肠恶性间质瘤影像学表现[J].中国医学影像技术,2005,21(4):622-624.
[13]宋彬,龚怡,张蓓,等.十二指肠间质瘤的螺旋CT表现[J].中国医学计算机成像杂志,2008,14(5):425-428.
[14] Sandrasegaran K,Rajesh A,Rushing DA,et al. Gastrointestinalstromal tumors:CT and MRI findings[J]. Eur Radiol,2005,15(7):1407-1414.
[15]陈晓煜,印隆林,谢欢,等. MRI联合序列检查在壶腹周围癌鉴别诊断中的价值[J].实用放射学杂志,2017,33(6):561-566.
[16]陈军法,王卫霞,王小鹏,等. MRI 3D-VIBE序列联合MRCP在胰胆管十二指肠连接区癌鉴别诊断中的价值[J].四川大学学报(医学版),2009,40(6):1110-1114.
[17] Kim JY,Lee JM,Han JK,et al. Contrast-enhanced MRI combinedwith MR cholangiopancreatography for the evaluation of patientswith biliary strictures:Differentiation of malignant from benign bileduct strictures[J]. J Magn Reson Imaging,2007,26(2):304-312.
[18]郝粉娥,牛广明,韩晓东,等. MRCP结合薄层T2WI对壶腹周围病变的诊断价值[J].实用放射学杂志,2008,24(11):1492-1495.
[19]孙娜娜,刘希胜,徐青,等. MR平扫及冠状面LAVA技术在低位胆管梗阻中的诊断价值[J].临床放射学杂志,2012,31(3):356-360.
[20]李绍东,徐凯,张秀莉,等.高场MRI动态增强联合MRCP在肝外癌性梗阻性黄疸中的应用[J].中国医学计算机成像杂志,2011,17(5):433-436.
[21]葛相栓,李建平,王慧超,等.十二指肠球部恶性肿瘤14例误诊分析[J].临床消化病杂志,2016,28(5):307-309.