Nagino M, Nimura Y, Hayakawa N, Kamiya J, Kondoh S, Shionoya S
First Department of Surgery, Nagoya University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1988 Jun;89(6):889-97.
The visualization of the caudate bile duct branch (B1) in computed tomography (CT-scan) with a high dose of contrast medium was evaluated in 71 patients with carcinoma of the liver, biliary tract and pancreas, preoperatively. The patients were classified into four groups: Group A, 22 patients (twelve hepatomas, six gall bladder cancers and four cancers of the pancreas body or tail) without abnormal findings in the biliary tract; Group B, two patients (cancer of the pancreas head and the common bile duct) with obstructive jaundice whose CT-scans were taken before percutaneous transhepatic cholangio-drainage (PTCD); Group C, 22 patients (16 cancers of the pancreas head and six common bile duct cancers) whose CT-scans were taken after release of jaundice by PTCD; Group D, 25 patients with carcinoma of the hepatic hilum whose CT-scans were taken after release of jaundice by PTCD. The results were as follows. 1) In Group A, B1 was invisible in all the patients. 2) In Group B, B1 was clearly visible in all the patients. But in Group C, B1 was visible only in one patient. 3) In Group D, B1 was visible in 19 out of 25 patients and in 18 patients out of these 19 patients, cancer invasion toward B1 was histopathologically confirmed. In contrast, invasion was revealed only in one out of six patients whose B1s were invisible. From these results, it is concluded that in carcinoma of the hepatic hilum the visualization of B1 in CT-scan after release of jaundice by PTCD strongly suggests the cancer invasion on B1, and requests the caudate lobe resection.
术前对71例肝脏、胆道和胰腺肿瘤患者进行了评估，以观察在高剂量造影剂增强的计算机断层扫描（CT扫描）中尾状叶胆管分支（B1）的显影情况。患者分为四组：A组，22例（12例肝癌、6例胆囊癌和4例胰体或胰尾癌），胆道无异常发现；B组，2例（胰头癌和胆总管癌）伴有梗阻性黄疸，在经皮经肝胆道引流（PTCD）前进行了CT扫描；C组，22例（16例胰头癌和6例胆总管癌），在PTCD解除黄疸后进行了CT扫描；D组，25例肝门部癌患者，在PTCD解除黄疸后进行了CT扫描。结果如下：1）A组所有患者B1均不可见；2）B组所有患者B1均清晰可见，但C组仅1例患者B1可见；3）D组25例患者中有19例B1可见，这19例患者中有18例经组织病理学证实癌组织侵犯B1。相比之下，B1不可见的6例患者中仅1例发现有侵犯。根据这些结果得出结论，对于肝门部癌，PTCD解除黄疸后CT扫描中B1显影强烈提示癌组织侵犯B1，需要进行尾状叶切除。
