目的 探讨腹部CT血管成像（CTA）检查在肝门胆管癌可切除性评估中的临床应用价值。方法 回顾2013年1月至2018年12月我院普外科胆道专业组收治的86 例病理检查证实肝门胆管癌病人的临床资料。本研究所有病人术前均行CTA检查,探讨其在肝门胆管癌术前诊断中的价值。结果 86例行手术治疗的肝门胆管癌病人,53例行根治性切除（R0切除）,根治率为61.63%。其余33例因血管侵犯、远处淋巴结转移、腹腔内广泛转移而行姑息性手术治疗。在肝门血管侵犯的评估方面,CTA诊断的准确性较高,其灵敏度为78.79%,特异度为92.45%,准确率为87.21%。在肝门淋巴结转移的评估方面,CTA诊断的灵敏度为42.86%。在远隔转移的评估方面,CTA诊断的灵敏度为42.86%。结论 CTA检查在判断肝门胆管癌血管受累程度上有一定优势,肝门淋巴结转移及远隔转移评估的灵敏度较差。
Objective To investigate the clinical value of abdominal CT angiography (CTA) in evaluating resectability of hilar cholangiocarcinoma. Methods The clinical data of 86 patients with hilar cholangiocarcinoma diagnosed pathologically in Department of Surgery this hospital were reviewed from January 2013 to December 2018. All patients underwent CT scan and CTA preoperatively for assessing of surgical resectability of hilar cholangiocarcinoma. Results A total of 53 patients (61.63%) had radical resection (R0 resection) in 86 patients with hilar cholangiocarcinoma. Remaining 33 patients underwent palliative surgery because of vascular invasion, distant lymph node metastasis or extensive intra-abdominal metastasis. CTA provided higher accuracy in evaluating major vascular invasion near the hepatic hilum with sensitivity 78.79%, specificity 92.45% and accuracy 87.21%. In evaluating lymph node metastasis near the hepatic hilum, CTA provided sensitivity only 42.86%. CTA evaluated distant metastasis with same sensitivity 42.86%. Conclusions CTA has certain advantages in evaluating major vascular invasion near the hepatic hilum. However, the sensitivity of CTA is poor in evaluating hilar lymph node metastasis and distant metastasis.
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