Romano L, Niola R, Valente T, Aloy G, Ansalone M, Pinto A
II Servizio di Radiologia, USL 40, Ospedale A. Cardarelli, Regione Campania, Napoli.
Radiol Med. 1994 Jun;87(6):808-13.
Eighteen patients with main biliary tract cholangiocarcinomas and no spread to the gallbladder and to the papilla of Vater underwent a combined US, ERCP/PTC and CT study. Angiography was performed on a selected group of 12 patients. We divided the infiltrating, polypoid or stenosing lesions in three groups: upper portion tumors, involving the confluence and the common hepatic duct (8 patients); middle portion tumors, originating from the common bile duct between the confluence of the cystic duct and the upper duodenal profile (6 patients); and finally lower third tumors, originating from the common bile duct between the upper rim of the duodenum and the papilla of Vater (4 patients). According to ERCP and/or PTC, US, CT and angiographic findings, only 9 of 18 cholangiocarcinomas were judged as resectable. The authors stress the need to optimize the use of imaging methods: US can locate the biliary obstruction; ERCP and/or PTC can show the tumor and its spread out of the duct, and finally angiography can exclude or confirm the vascular involvement of the hepatic hilum.
18例主胆管胆管癌患者，肿瘤未扩散至胆囊及Vater壶腹，接受了超声、内镜逆行胰胆管造影（ERCP）/经皮经肝胆管造影（PTC）及CT联合检查。对其中12例患者进行了血管造影。我们将浸润性、息肉样或狭窄性病变分为三组：上部肿瘤，累及汇合部及肝总管（8例）；中部肿瘤，起源于胆囊管汇合部与十二指肠上缘之间的胆总管（6例）；最后是下1/3肿瘤，起源于十二指肠上缘与Vater壶腹之间的胆总管（4例）。根据ERCP和/或PTC、超声、CT及血管造影结果，18例胆管癌中只有9例被判定可切除。作者强调需要优化影像学方法的使用：超声可定位胆管梗阻；ERCP和/或PTC可显示肿瘤及其在胆管外的扩散情况，最后血管造影可排除或确认肝门部血管受累情况。
