CT診斷在鑒別肝細(xì)胞癌與肝膽管細(xì)胞癌中的應(yīng)用

[摘要] 目的 探討CT診斷在鑒別肝細(xì)胞癌與肝膽管細(xì)胞癌中的應(yīng)用效果。方法 方便選取2013年9月—2016年7月該院收治的經(jīng)手術(shù)證實(shí)的63例肝細(xì)胞癌患者及20例肝膽管細(xì)胞癌患者進(jìn)行研究，分別對(duì)所有患者行B超檢查和64排螺旋CT動(dòng)態(tài)增強(qiáng)掃描，比較兩種檢查方式的診斷效能。結(jié)果 CT診斷肝細(xì)胞癌的病理診斷符合率為92.1%，肝膽管細(xì)胞癌的病理診斷符合率為85.0%； B超分別為77.8%和55.0%，CT診斷肝細(xì)胞癌和肝膽管細(xì)胞癌的病理診斷符合率均明顯高于B超。肝細(xì)胞癌患者中合并肝硬化、HBsAg陽(yáng)性、AFP升高等人數(shù)明顯多于肝膽管細(xì)胞癌患者，合并結(jié)石及淋巴結(jié)轉(zhuǎn)移者明顯少于肝膽管細(xì)胞癌；CT診斷肝細(xì)胞癌和肝膽管細(xì)胞癌存在特異性差異。 結(jié)論 螺旋CT增強(qiáng)掃描與延遲掃描能有效提高肝細(xì)胞癌和肝膽管細(xì)胞癌的診斷準(zhǔn)確率，且可結(jié)合患者的臨床資料及并發(fā)癥影像學(xué)檢查結(jié)果對(duì)二者進(jìn)行鑒別，具有較高的臨床應(yīng)用價(jià)值。

[關(guān)鍵詞] 肝細(xì)胞癌；肝膽管細(xì)胞癌；CT診斷；鑒別診斷

[中圖分類(lèi)號(hào)] R445 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-0742（2016）12（c）-0190-03

[Abstract] Objective To investigate the application effect of CT in the diagnosis of hepatocellular carcinoma and cholangiocarcinoma. Methods Convenient selection 63 cases of hepatocellular carcinoma and 20 cases of hepatocellular carcinoma in our hospital were studied. The diagnostic efficacy of the two methods of dynamic enhanced scan and spiral CT scan in all patients were compared. Results The pathological diagnosis of CT diagnosis of hepatocellular carcinoma with the rate of 92.1%， the pathological diagnosis of hepatobiliary cancer with the rate of 85.0%； B were 77.8% and 55.0%， pathological diagnosis coincidence rate of CT diagnosis of hepatocellular carcinoma and liver and gallbladder carcinoma were significantly higher than the rate of B ultrasound diagnosis. The number of patients with hepatocellular carcinoma complicated with cirrhosis， HBsAg positive， AFP were significantly higher than those in hepatocholangiocarcinoma patients， with stones and lymph node metastasis were significantly less than those of hepatocholangiocarcinoma patients. There is specific differences between CT diagnosis of hepatocellular carcinoma and hepatocholangiocarcinoma. Conclusion Spiral CT scan and delayed scan can effectively improve the diagnosis of hepatocellular carcinoma and hepatocholangiocarcinoma accuracy and examination results， identify hepatocellular carcinoma and hepatocholangiocarcinoma combination of the clinical data and complications of patients， it has a high clinical value.

[Key words] Hepatocellular Carcinoma； Hepatocholangiocarcinoma； CT Diagnosis； Differential Diagnosis

肝細(xì)胞癌和肝膽管細(xì)胞癌均屬于原發(fā)性肝癌，其中肝細(xì)胞癌發(fā)病率占原發(fā)性肝癌的90%以上，肝膽管細(xì)胞癌則占5%左右[1]。原發(fā)性感染、起病隱匿，早期患者多缺乏典型癥狀，臨床確診困難，多數(shù)患者就診時(shí)已處于中晚期。作為兩種最為常見(jiàn)的原發(fā)性肝癌，肝細(xì)胞癌和肝膽管細(xì)胞癌具有非常相抵的生物學(xué)行為，膽管細(xì)胞癌確診后即使門(mén)靜脈受到侵犯時(shí)仍可通過(guò)手術(shù)將其腫瘤全部切除，患者預(yù)后良好，但肝細(xì)胞癌侵犯門(mén)靜脈時(shí)已屬于晚期，患者預(yù)后極差[2]?！?br>