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目的探讨64层螺旋CT三维重建成像在肝胆胰系统疾病中的诊断价值,总结临床经验以提高影像学诊断水平。方法对2013年2月—2016年2月收治的110例肝胆胰系统疾病患者给予64层螺旋CT检查以及三维重建成像处理,立体、多角度观察病灶、胰胆管结构及门静脉系统的特点,并根据手术情况进行全面分析。结果30例门静脉高压症患者的三维重建成像能够清晰地显示出门静脉的主干、侧支循环情况。38例原发性肝癌患者中对附近组织、血管未侵犯者25例,侵犯者10例,门静脉右支癌栓2例,肝内动脉-门静脉瘘1例。胰胆疾病42例,肝内胆管结石10例,胆囊、胆管结石20例以及肝门部胆管癌4例、胰头癌4例、胆管下端癌2例、壶腹部癌2例的胆道三维重建成像可以明显地显示出肿瘤及结石,并根据检查结果制定出可行的手术方案。门静脉高压症、肝癌、胆胰疾病的影像学诊断结果同手术探查结果具有较高的一致率,分别是100%(30/30)、94.74%(36/38)、100%(42/42)。结论肝胆胰系统的解剖结构、影像学表现均复杂,而64层螺旋CT三维重建成像能够立体、多角度地显示该系统病灶及脏器的具体结构,准确地表现出病灶与邻近组织的关系,从而为手术提供了重要参考,临床应用价值较高。
Objective To investigate the value of 64-slice spiral CT three-dimensional reconstruction imaging in the diagnosis of hepatobiliary and pancreatic diseases and summarize the clinical experience to improve the diagnostic accuracy of imaging. Methods A total of 110 patients with hepatobiliary and pancreatic diseases who were treated from February 2013 to February 2016 were evaluated by 64-slice spiral CT and three-dimensional reconstruction imaging. The characteristics of the lesion, pancreatic duct and portal system were observed stereoscopically and multi-anglely. A comprehensive analysis of the operation. Results Three-dimensional reconstruction images of 30 patients with portal hypertension can clearly show the main trunk and collateral circulation of portal vein. Among 38 patients with primary liver cancer, 25 cases were noninvasive to nearby tissues and vessels, 10 cases were involved in invasion, 2 cases were tumor thrombus of right portal vein and 1 case was intrahepatic arterial-portal vein fistula. 42 cases of pancreaticobiliary disease, 10 cases of intrahepatic bile duct stones, 20 cases of gallbladder and bile duct stones, 4 cases of hilar cholangiocarcinoma, 4 cases of pancreatic head cancer, 2 cases of biliary lower end carcinoma, 2 cases of ampullary carcinoma biliary tract three-dimensional reconstruction imaging Can clearly show the tumor and stones, and based on the test results to develop a viable surgical options. The results of imaging diagnosis of portal hypertension, hepatocellular carcinoma and biliary and pancreatic diseases showed high agreement with surgical exploration results, which were 100% (30/30), 94.74% (36/38), 100% (42/42) . Conclusion The anatomical structure and imaging features of hepatobiliary and pancreatic system are complex. However, the three-dimensional reconstruction of 64-slice spiral CT can display the specific structures of lesions and organs of the system stereoscopically and multi-anglely, accurately showing the relationship between lesions and adjacent tissues, So as to provide an important reference for surgery, clinical application of higher value.