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目的:探讨术前CT三维重建在肝门部胆管癌的诊断和可切除性评估中的应用价值。方法:回顾性分析安徽医科大学附属省立医院自2015年1月—2016年12月收治的15例肝门部胆管癌患者资料,所有患者术前常规行CT三维重建,分析肿瘤的位置与毗邻关系以及Bismuth分型,从而进行手术的可切除性评估。结果:15例患者均完成手术探查,其中Bismuth分型Ⅱ型1例,Ⅲ型5例(Ⅲa型2例,Ⅲb型3例),Ⅳ型9例,其中根治性手术11例,姑息性切除术4例。CT三维重建在术前诊断肝门部胆管癌分型、肿块与门静脉及肝动脉比邻关系、肿块体积的准确率分别为93.3%、86.7%、53.3%、93.3%;术前模拟手术与实际手术方式符合率为80%。结论:术前CT三维重建可以准确、直观、动态的显示肝门部胆管癌及三维毗邻关系,对于判断肝门部胆管癌的可切除性具有较高的准确性,值得临床推广。
Objective: To investigate the value of three-dimensional reconstruction of preoperative CT in the diagnosis and resectability of hilar cholangiocarcinoma. Methods: The data of 15 cases of hilar cholangiocarcinoma admitted to Provincial Hospital Affiliated to Anhui Medical University from January 2015 to December 2016 were retrospectively analyzed. All patients underwent preoperative CT three-dimensional reconstruction routinely. The location of tumor and adjacent Relationship and Bismuth classification to assess the resectability of the surgery. Results: All the 15 patients underwent surgical exploration. There were 1 case of type Ⅱ Bismuth, 5 cases of type Ⅲ, 2 cases of type Ⅲ a and 3 cases of type Ⅲ b, 9 cases of type Ⅳ, including 11 cases of radical surgery and palliative resection Surgery in 4 cases. CT three-dimensional reconstruction in the preoperative diagnosis of hilar cholangiocarcinoma type, mass and portal vein and hepatic artery adjacent relationship, the volume of the mass accuracy of 93.3%, 86.7%, 53.3%, 93.3%; preoperative simulation and actual surgery Way in line with the rate of 80%. CONCLUSION: Three-dimensional reconstruction of preoperative CT can accurately, directly and dynamically display the hilar cholangiocarcinoma and the three-dimensional contiguity. It is of high accuracy in judging the resectability of hilar cholangiocarcinoma and is worthy of clinical promotion.