Bach A M, Loring L A, Hann L E, Illescas F F, Fong Y, Blumgart L H
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Ultrasound Med. 1998 May;17(5):303-9. doi: 10.7863/jum.1998.17.5.303.
This study reviews the spectrum of sonographic findings in patients with gallbladder cancer, attempts to determine if sonography can identify patients with potentially resectable disease, and emphasizes the limitations of ultrasonography in the evaluation of -gallbladder cancer. Thirty-five consecutive patients with histologically proven gallbladder carcinoma who had preoperative abdominal ultrasonography and surgery were identified. Involvement of the gallbladder and gallbladder fossa, metastases, bile ducts, portal vein, and adjacent lymph nodes was assessed sonographically. The extent of disease and staging as revealed by sonography was compared to operative and surgical pathologic findings. Masses in the gallbladder or gallbladder fossa were present at surgery in 26 patients; 22 (85%) of these masses were shown by sonography. Sonography identified six (67%) of nine cases of pathologically confirmed liver metastases, 11 (79%) of 14 cases of bile duct involvement, and two (67%) of three cases of portal venous involvement by tumor. Sonography revealed lymph node metastases in only five (36%) of 14 patients. None of the 12 cases with peritoneal metastases was identified sonographically. By surgical staging 16 (46%) patients had potentially resectable disease (stage III or less), and 19 (54%) patients had unresectable stage IV disease. Sonography correctly identified 15 (94%) of 16 patients with potentially resectable disease and seven (37%) of 19 patients with advanced disease. Twelve patients with advanced disease were under-staged: nine had peritoneal metastases, two had liver metastases, and one had celiac adenopathy, which was not shown by sonography. In conclusion, sonography is reliable in the detection of a primary gallbladder mass or of local extension of tumor into the liver. However, sonographic findings do not accurately reflect the full extent of disease, and sonography is particularly limited in the diagnoses of metastases to the peritoneum and lymph nodes.
本研究回顾了胆囊癌患者的超声检查结果范围，试图确定超声检查能否识别出具有潜在可切除疾病的患者，并强调了超声检查在评估胆囊癌方面的局限性。确定了35例经组织学证实为胆囊癌且术前行腹部超声检查及手术的连续患者。通过超声检查评估胆囊及胆囊窝、转移灶、胆管、门静脉和相邻淋巴结的受累情况。将超声检查所显示的疾病范围和分期与手术及手术病理结果进行比较。26例患者手术时发现胆囊或胆囊窝有肿块；其中22例（85%）肿块经超声检查显示。超声检查发现9例经病理证实的肝转移病例中的6例（67%）、14例胆管受累病例中的11例（79%）以及3例肿瘤侵犯门静脉病例中的2例（67%）。超声检查仅发现14例患者中的5例（36%）有淋巴结转移。12例腹膜转移病例中超声检查均未发现。根据手术分期。16例（46%）患者有潜在可切除疾病（Ⅲ期或以下），19例（54%）患者有不可切除的Ⅳ期疾病。超声检查正确识别出16例有潜在可切除疾病患者中的15例（94%）和19例晚期疾病患者中的7例（37%）。12例晚期疾病患者分期过低：9例有腹膜转移，2例有肝转移，1例有腹腔淋巴结肿大，超声检查均未显示。总之，超声检查在检测原发性胆囊肿块或肿瘤向肝脏的局部扩展方面是可靠的。然而，超声检查结果不能准确反映疾病的全貌，超声检查在诊断腹膜和淋巴结转移方面尤其有限。
