CAJ | 학술논문

正确诊断是准确外科治疗的前提.十二指肠乳头癌是阻塞性黄疸中一种比较常见的原因,但术前的影像诊断很少做出准确的定位、定性诊断,甚至导致临床误诊、误治,随后再行第二次手术.作者从2003年1月至2012年12月诊治十二指肠乳头癌29例,术前都做出准确的定位诊断和拟诊十二指肠乳头癌的定性诊断.通过临床-影像-病理的对照性研究,总结出十二指肠乳头癌几种影像检查(超声、CT、磁共振、PTC、T管造影)具有以下七项共同特点:(1)胆囊大,肝内外胆管全程重度扩张,或伴有胰管扩张；(2)横断面图像显示,胆、胰管并列扩张(双管征)；(3)横断面图像胆管在超低位(肾门水平)圆形扩张；(4)横断面图像有“苹果把征”；(5)冠状面图像显示,胆管在超低位(腰椎2水平)有截断、偏心性或不规则狭窄；(6)CT横断面在十二指肠内侧有占位；(7) MRCP在乳头部位出现不规则低信号占位.单独或联合影像检查,只要具有第一项和其他六项中的任何一项,就可做出十二指肠乳头癌的诊断,进而提高外科决策的正确性.
정학진단시준학외과치료적전제.십이지장유두암시조새성황달중일충비교상견적원인,단술전적영상진단흔소주출준학적정위、정성진단,심지도치림상오진、오치,수후재행제이차수술.작자종2003년1월지2012년12월진치십이지장유두암29례,술전도주출준학적정위진단화의진십이지장유두암적정성진단.통과림상-영상-병리적대조성연구,총결출십이지장유두암궤충영상검사(초성、CT、자공진、PTC、T관조영)구유이하칠항공동특점:(1)담낭대,간내외담관전정중도확장,혹반유이관확장；(2)횡단면도상현시,담、이관병렬확장(쌍관정)；(3)횡단면도상담관재초저위(신문수평)원형확장；(4)횡단면도상유“평과파정”；(5)관상면도상현시,담관재초저위(요추2수평)유절단、편심성혹불규칙협착；(6)CT횡단면재십이지장내측유점위；(7) MRCP재유두부위출현불규칙저신호점위.단독혹연합영상검사,지요구유제일항화기타륙항중적임하일항,취가주출십이지장유두암적진단,진이제고외과결책적정학성.
Precise diagnosis is the premise of precise surgery.Duodenal papillary carcinoma is one cause of obstructive jaundice,but the several preoperative diagnostic imaging investigations (including Ultrosonography,CT,MRI with MRCP,PTC,T-tube chalangiogrphy) can not make the correct diagnosis of the tumor in location and nature.In some cases,the error diagnoses resulted in error surgeries which led to reoperations.During a period of ten years from the beginning of 2003 to the end of 2012,29 cases with the entity made the correct diagnosis by surgeons in location and partly correct in nature.Based on the experience of these cases,comparing the data from clinic pictures,imaging findings and pathologic observations,seven common characters for the diagnostic imaging investigation were valuable to make precise diagnosis of duodenal papillary carcinoma.These common characteristics are listed as:(1) dilated gallbladder,marked intra-and extrahepatic biliary ductal dilatation in whole range,may combine dilation of pancreatic duct;(2) on cross-sectional imaging as a double-duct sign,which results from obstruction of both the distal common bile duct and the proximal pancreatic duct; (3) on cross-sectional imaging as a cyclo-dilatation at the level of renal hilum;(4) on cross-sectional imaging as a apple-stem sign,which results from dilated common bile duct and the normally proximal pancreatic duct; (5) on coronal plane imaging at the level of second lumbar vertebrae as a cutoff,or eccentricity,or irregular strcture ; (6) on cross-sectional imaging of CT imaging as a mass located at duodenum near the side of pancreas; (7) on MRCP examinations as a mass with hypointensity at the level of duodenal papilla.Any imaging examination alone,or combined examination show first characteristic with any one of the other six characteristics,the diagnosis of duodenal papillary carcinoma may be made,subsequently followed by a correct surgical decision.