摘要
目的探讨多层螺旋CT(MSCT)在肝泡状棘球蚴病的诊断及可切除性评估中的价值。方法回顾性分析2013年12月至2015年5月期间四川大学华西医院收治的28例经手术及病理学检查证实为肝泡状棘球蚴病患者的CT表现,并将MSCT所见与手术病理结果行对照分析。结果 28例共检出肝内病灶45个,主要表现为形态不规则、不均质的浸润性低密度影,伴高密度钙化及更低密度的坏死区,平扫边界模糊而增强后界限清楚,增强扫描病灶未见明显强化,部分边缘及分隔轻度强化。MSCT血管三维重建图像显示血管受累表现为肝内血管的推挤、受压、移位、狭窄、包绕或中断。MSCT所见与手术结果比较,对判断血管受累的敏感度及特异度,肝动脉为67%及97%,门静脉为83%及93%,肝静脉为84%及91%,下腔静脉为85%及100%。12例MSCT评估认为可根治切除者与手术结果判断基本一致,16例MSCT评估不能根治切除中仅2例通过对受累的大血管及胆管进行部分切除、修复和重建得以根治性治疗。结论 MSCT能对肝泡状棘球蚴病进行准确的术前诊断及显示血管受侵犯情况,对于评价可切除性及手术方式的制定具有重要价值。
Objective To assess the value of multi-slice spiral CT （MSCT） in the diagnosis and resectability judgement of hepatic alveolar echinococcosis （HAE）. Methods The CT findings of 28 patients who were confirmed HAE by surgical pathological examination were retrospectively analyzed. Comparative analysis were made between the CT findings and surgical pathology. Results Altogether 45 lesions in hepatic were detected. Lesions mainly revealed an infiltrating tumor-like hepatic mass with irregular margins and heterogeneous contents with varied attenuation, including scattered hyper-attenuating calcifications and hypo-attenuating areas corresponding to necrosis, no substantial enhancement, however, the fibro-inflammatory component surrounding the parasitic tissue was enhanced faintly in the delayed phase, and clearly demarcated from surrounding parenchyma. MSCT angiography （CTA） depicted signs of infiltration of hepatic vessels such as pushed, compression, displacement, stenosis, encasement and interruption. Compared with findings of operation, the sensitivity and specificity value of MSCT for evaluating the hepatic artery system disorders were 67%, 97%; and for portal venous system were 83%, 93%; and for hepatic venous system were 84%, 91%; while for inferior vena cava were 85%, 100%. Twelve cases which were evaluated as resectable by MSCT were in accordance with surgical findings. In the rest 16 patients which were iudged as non-resectable by MSCT, only 2 patients were radical treatment through partial excision, repair and reconstruction for the involvement of large vessels and bile ducts. Conclusion MSCT is accuracy in the diagnosis and assessment of vessels complication of HAE. It has an important value to evaluate the resectability of HAE and the planning of treatment.
出处
《中国普外基础与临床杂志》
CAS
2016年第1期104-108,共5页
Chinese Journal of Bases and Clinics In General Surgery
基金
四川省科技支撑计划(项目编号:2012SZ0149)
四川省科技支撑计划(项目编号:2014SZ0150)~~
