Diagnosis of biliary tract and ampullary carcinomas
Diagnosis of biliary tract and ampullary carcinomas
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DOI：
10.1007/s00534-007-1278-6
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发表时间：
2008-01-01
期刊：
影响因子：
--
通讯作者：
Miura, Fumihiko
中科院分区：
文献类型：
--
作者：
Tsukada, Kazuhiro;Takada, Tadahiro;Miura, Fumihiko
对胆道癌的诊断方法和疗效进行了讨论。本病既无明确的早期诊断方法，也无特异性标记物。当根据临床症状和危险因素怀疑本病时，进行血液生化检查和腹部超声检查，并在适当的情况下进行增强计算机断层扫描(CT)和/或磁共振胆胰管成像(MRCP)。肝外胆管癌和壶腹癌的诊断通常基于梗阻性黄疸的存在。虽然罕见，但腹痛和发热，以及血液生化检查发现的肝胆系统异常，可作为诊断这些疾病的线索。另一方面，根据临床症状很难早期诊断出胆囊癌，所以当发现这种癌症时出现腹痛和黄疸时，在发现时就已经进入晚期，从而使治愈变得困难。当怀疑胆囊癌时，进行增强CT检查。尤其是多层计算机断层扫描(MDCT)--增强CT的一种方法--对于手术标准的决定是有用的，因为MDCT可以显示肿瘤的定位和扩展，以及有无远处转移。在进行磁共振成像、超声内窥镜检查、胆管活检和胆道镜检查时，应考虑到个别患者的适应证。然而，直接胆道成像对于胆道癌水平扩展的准确诊断是必要的。
Diagnostic methods for biliary tract carcinoma and the efficacy of these methods are discussed. Neither definite methods for early diagnosis nor specific markers are available in this disease. When this disease is suspected on the basis of clinical symptoms and risk factors, hemato-biochemical examination and abdominal ultrasonography are performed and, where appropriate, enhanced computed tomography (CT) and/or magnetic resonance cholangiopancreatography (MRCP) is carried out. Diagnoses of extrahepatic bile duct cancer and ampullary carcinoma are often made based on the presence of obstructive jaundice. Although rare, abdominal pain and pyrexia, as well as abnormal findings of the hepatobiliary system detected by hemato-biochemical examination, serve as a clue to making a diagnosis of these diseases. On the other hand, the early diagnosis of gallbladder cancer is scarcely possible on the basis of clinical symptoms, so when this cancer is found with the onset of abdominal pain and jaundice, it is already advanced at the time of detection, thus making a cure difficult. When gallbladder cancer is suspected, enhanced CT is carried out. Multidetector computed tomography (MDCT), in particular - one of the methods of enhanced CT - is useful for decision of surgical criteria, because MDCT shows findings such as localization and extension of the tumor, and the presence or absence of remote metastasis. Procedures such as magnetic resonance imaging, endoscopic ultrasonography, bile duct biopsy, and cholangioscopy should be carried out taking into account indications for these procedures in individual patients. However, direct biliary tract imaging is necessary for making a precise diagnosis of the horizontal extension of bile duct cancer.