应用CT三维重建技术判断肝门部胆管癌可切除性价值分析*

doi:10.3969/j.issn.1672-5069.2020.06.033

摘要/Abstract

摘要： 目的研究应用CT三维重建技术判断肝门部胆管癌可切除性的价值。方法 2016年5月～2019年5月我院收治89例肝门部胆管癌患者,于术前行常规CT和增强扫描三维重建,判断肿瘤Bismuth-Corlette分型、周围血管受累和淋巴结转移。对能手术者施行肿瘤切除手术。结果术后组织病理学检查显示,89例肝门部胆管癌患者Bismuth-Corlette分型Ⅰ型13例,Ⅱ型13例,Ⅲa型11例,Ⅲb型28例,Ⅳ型24例,CT三维重建分型的准确率为93.3%;CT三维重建技术评估肝动脉和门静脉受累及淋巴结转移的Kappa值分别为0.7、0.7和0.3,灵敏度分别为87.5%、87.5%和62.5%,特异度分别为89.2%、86.0%和75.3%,准确率分别为88.8%、86.5%和73.0%,阳性预测值分别为75.0%、77.8%和35.7%,阴性预测值分别为95.1%、92.5%和90.2%;经实际手术验证,CT三维重建技术评估肝门部胆管癌可切除性的Kappa值为0.7,灵敏度为98.2%,特异度为65.6%,准确率为86.5%,阳性预测值为83.6%,阴性预测值为95.5%。结论术前CT三维重建能准确地显示肝门部胆管癌肿瘤病灶Bismuth-Corlette分型、周围血管受累和淋巴结转移,对判断手术可切除性具有较大的指导意义。

关键词: 肝门部胆管癌, CT, 三维重建, 手术

Abstract: Objective The aim of this study was to explore the value of three-dimensional CT reconstruction in evaluating theresectability of tumorsin patients withhilar cholangiocarcinoma. Methods 89 patients with hilar cholangiocarcinoma were admitted to our hospital from May 2016 through May 2019,and underwent surgical removal of tumors. Before operation, all the patients received three-dimensional reconstruction of conventional CT scan to determine Bismuth-Corlette classification, peripheral vascular involvement and lymph node metastasis. Results The post-operational histopathological examination showed that out the 89 patients, there wereBismuth-Corlette class Ⅰ in 13, class Ⅱ in 13, class Ⅲa in 11, class Ⅲb in 28 and class Ⅳ in 24, and the accuracy (Ac) of CT reconstruction was 93.3%; as to the efficacies of CT reconstruction in judging hepatic artery and portal vein involvement as wellaslymph node metastasis, the Kappa values were 0.7, 0.7 and 0.3, the sensitivities (Se) were 87.5%, 87.5% and 62.5%, the specificities (Sp) were 89.2%, 86.0% and 75.3%, the Acs were 88.8%, 86.5% and 73.0%, the positive predictive values (PPV) were 75.0%, 77.8% and 35.7%, and the negative predictive values (NPV) were 95.1%, 92.5% and90.2%,respectively; the Kappa was 0.7, the Se was 98.2%, the Sp was 65.6%, the Ac was 86.5%, the PPV was 83.6% and the NPV was 95.5% by CT reconstruction in evaluating theresectability of tumors. Conclusion The application of CT three-dimensional reconstruction before operation in patients withhilar cholangiocarcinoma could help display Bismuth-Corlette typing, peripheral vascular involvement and lymph node metastasis, which might be useful in judging theresectability of tumors.

Key words: Hilar cholangiocarcinoma, CT, Three-dimensional reconstruction, Surgery

武盼盼, 徐蒙莱, 褚建华, 鲍亚星. 应用CT三维重建技术判断肝门部胆管癌可切除性价值分析^*[J]. 实用肝脏病杂志, 2020, 23(6): 889-892.

Wu Panpan, Xu Menglai, Chu Jianhua, et al. Application of three-dimensional CT reconstruction in evaluatingresectability of tumors in patients with hilar cholangiocarcinoma[J]. Journal of Practical Hepatology, 2020, 23(6): 889-892.

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应用CT三维重建技术判断肝门部胆管癌可切除性价值分析^*

Application of three-dimensional CT reconstruction in evaluatingresectability of tumors in patients with hilar cholangiocarcinoma

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