64层螺旋CT在梗阻性黄疸诊断中的临床应用

目的评价64层螺旋CT在梗阻性黄疸诊断中的准确性和临床应用价值。方法收集125例行64层螺旋CT扫描并确诊梗阻性黄疸患者，回顾性分析临床和CT影像资料，对胆道梗阻的部位和病因进行定位、定性分析。并与手术病理、内镜逆行胰胆管造影（ERCP）结果对照。结果良性梗阻病变79例，其中胆道结石64例，炎性病变11例，先天性胆管囊肿4例；恶性梗阻病变46例，其中胆管癌25例，胰头癌12例，壶腹癌3例，胆囊癌5例。肝癌侵犯肝门区胆管1例。64层螺旋CT定位诊断准确率为100．0％，定性诊断准确率为96．8％。结论64层螺旋CT对梗阻性黄疸的病变显示清晰，结合多平面重建（MPR）、曲面重建（CPR）等图像后处理，能直观、立体地显示胆道梗阻的部位，对梗阻病因的诊断和鉴别诊断有较高的临床价值。

Clinical application of 64 slices spiral CT in diagnosis of obstructive jaundice

Objective To assess the accuracy and clinical value of 64 slice spiral CT in diagnosing obstructive jaundice. Methods 125 patients with obstructive jaundice underwent 64 slice spfial CT scanning, all the cases were clini- cally confirmed. The clinical features were restrospectively reviewed by comparing with CT imagings, including analyzing obstructive locations and features, comparing surgical and pathological findings with the ERCP results. Results The study demonstrated that there were 64 cases of biliary calculis, 11 cases of inflammatory lesions and 4 cases of congenital choledochal cysts in 79 cases of benign lesions. And in 46 cases of malignant lesions there were 25 cases of cholangiocarcinomas, 12 cases of pancreatic head carcinomas, 3 cases of carcinoma of ampullas, 5 cases of gallbladder carcinomas and 1 case of biliary duct near hepatic hilar region invaded by liver cancer. The accuracy of location diagnostic for obstructive lesions by 64 slice spiral CT was 100.0%, the accuracy of qualitative diagnosis was 96.8%. Conclusion The 64 slice spiral CT can clearly show the obstructive jaundice lesions, combining with MPR and CPR could directly and stereoscopically show the obstructive location, so that it has important significance for the etiology and differential diagnosis of obstructive iaundice.