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目的研究64排CT胆道和血管三维重建(CTA)在肝门部胆管癌术前评估中的应用价值和优缺点。方法对2006年3月至2006年12月8例肝门部胆管癌病人进行增强CT扫描并进行肝动脉、门静脉三维重建,判断肝动脉和门静脉侵犯情况。通过PTBD胆道内注入6.9%泛影葡胺,进行CT平扫和阳性法胆道三维重建,判断肝内胆管的侵犯情况。利用上述结果进行Bismuth-Corlette分型和T分期。术前评估结果与手术探查结果进行对比。结果8例病人均可成功进行CT重建肝动脉,门静脉的三维重建。2例肝动脉系统侵犯病人CTA结果与手术探查一致,5例门静脉系统侵犯病人,3例一致。6例病人肝内胆管1~4级分支在胆道三维重建时能完全显影,2例病人部分显影。7例病人的Bismuth-Corlette分型和6例T分期术前评估结果与手术探查一致。结论64排CT下胆道和血管三维重建,可作为肝门部胆管癌术前评估的常规方法,其应用价值值得进一步的研究和分析。
Objective To study the value, advantages and disadvantages of 64-slice CT biliary and vascular reconstruction (CTA) in preoperative evaluation of hilar cholangiocarcinoma. Methods Eight patients with hilar cholangiocarcinoma from March 2006 to December 2006 underwent enhanced CT scan and three-dimensional reconstruction of the hepatic artery and portal vein to determine the violation of the hepatic artery and portal vein. Through the PTBD biliary tract injection of 6.9% diatrizoate, CT scan and positive bile duct reconstruction three-dimensional, to determine the situation of intrahepatic bile duct violations. Bismuth-Corlette typing and T staging were performed using the above results. Preoperative evaluation results and surgical exploration results were compared. Results Eight patients were successfully reconstructed by three-dimensional reconstruction of the hepatic artery and portal vein. Two cases of hepatic artery invasion of patients with CTA results consistent with surgical exploration, 5 cases of portal vein invasion of patients, 3 cases were consistent. 6 patients with intrahepatic bile duct 1 to 4 branches in the three-dimensional reconstruction of the biliary can be fully developed, 2 patients partially developed. The Bismuth-Corlette classification of the seven patients and the preoperative evaluation of six T-staging were consistent with surgical exploration. Conclusion Three-dimensional reconstruction of biliary tract and blood vessels with 64-slice CT can be used as a routine method for the preoperative evaluation of hilar cholangiocarcinoma. Its value of application deserves further study and analysis.