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目的探讨多层螺旋CT(MSCT)双期扫描三维重建预测胆囊癌手术可切除性的价值。方法40例临床和超声检查疑为胆囊癌的患者接受前瞻性MSCT双期扫描,其中剖腹探查行胆囊癌根治性切除术和姑息性切除术35例。剖腹探查患者MSCT双期扫描的图像行3D容积再现重建和多平面重建,根据其表现进行分期、评估血管侵犯情况和血管解剖、预测手术可切除性,并与手术结果对照。结果根据CT表现,13例为可切除,22例为不可切除。手术可切除17例,不可切除18例。CT分期偏高4例。手术可切除敏感性为76.5%,特异性100%,阳性预测值100%,阴性预测值为81.8%,准确性为88.6%。肝脏、血管、胆管侵犯,腹主动脉淋巴结转移,CT诊断与手术的符合率为100%。CT显示9例血管变异,6例在根治性切除术中证实。结论MSCT双期扫描三维重建有助于预测胆囊癌手术可切除性和制定根治性手术血管入路。
Objective To investigate the value of multi-slice spiral CT (MSCT) double-phase three-dimensional reconstruction in predicting the resectability of gallbladder carcinoma. Methods Forty patients with suspected gallbladder cancer undergoing clinical and ultrasonography were prospectively scanned by MSCT. Among them, 35 cases underwent radical resection of gallbladder and palliative resection in laparotomy. The patients underwent laparotomy for MSCT double-phase scan. The images were reconstructed and multiplanar reconstructed by 3D volume reconstruction. The patients were staged according to their performance. The vascular invasion and vascular anatomy were evaluated. The surgical resectability was predicted and compared with the surgical results. Results According to CT findings, 13 cases were resectable and 22 cases were unresectable. Surgical resection in 17 cases, unresectable in 18 cases. CT staging high in 4 cases. Surgical excision sensitivity was 76.5%, specificity was 100%, positive predictive value was 100%, negative predictive value was 81.8%, and accuracy was 88.6%. Liver, blood vessels, bile duct invasion, abdominal aortic lymph node metastasis, CT diagnosis and surgery in line with the rate of 100%. CT showed 9 cases of vascular variability, 6 cases confirmed by radical resection. Conclusion MSCT dual-phase three-dimensional reconstruction of the scan is helpful to predict the resectability of the gallbladder carcinoma and to establish the radical surgical approach.