腹部超音波檢查對膽囊癌術前診斷的價值

The Clinical Significance of Abdominal Sonography in Preoperative Diagnosis of Gallbladder Carcinoma

王朝欣(Chaur-Shine Wang) ； 李偉明(Wei-Ming Lee) ； 羅海韻(Hoi-Wan Lo) ； 林光洋(Kuang-Young Lin) ； 劉正典(Jean-Dean Liu) ； 蕭泉豹(Chuan-Pau Siauw) ； 陳寶輝(Pao-Huei Chen) ； 劉茂和(Mao-Ho Liu) ； 姜良忠(Liang-Chung Chiang)

《中華民國消化系醫學會雜誌》 1卷1期 (1984/01) Pp. 18-25

https://doi.org/10.6557/GJTa.198401_1(1).0004

摘要

分析13例經手術證實的膽囊癌之術前診斷過程，發現未引用超音波檢查前之5例中，僅1例因經內視鏡逆行性膽胰管攝影術(ERCP)顯出膽囊內有不規則缺損，並具Mirriz氏症侯羣，即總膽管有片壓現象而疑為膽囊癌汁，其他4例之術前診斷分別為：膽囊結石2例，慢性膽囊炎大腸癌各1例。使用超音波檢查後之8例中，除1例外，其餘7例都是手術前經超音波檢查診斷為膽囊癌之後追加其他檢查，最後經手術證實。由於腫瘤的直接侵犯、膽囊結石、膽囊炎造成膽囊管阻塞或膽囊喪失功能，使膽囊無法顯影，是一般膽囊映像檢查口服及點滴法膽囊攝影術，經內視鏡逆行性膽胰管攝影法及經皮穿肝膽管攝影法對膽囊癌診斷困難的主要原因。反之，超音波檢查不但簡便，無侵襲性，為目前公認唯一能有效顯出膽囊壁及其病變之檢查方法，不論膽囊管是否阻塞，膽囊是否失功能，皆可直接顯示膽囊壁及膽囊內腫瘤之大小位置，同時描繪出膽囊外侵潤範圍，及轉移部位，是目前膽囊癌術前診斷最有效的方法。超音波檢查對良性膽囊腫瘤，慢性膽囊炎與膽囊癌之間的鏗別診斷仍有困難。超音波指引下細針膽囊穿刺細胞診為目前最可靠的術前正確診斷方法。

關鍵字

gallbladder carcinoma ； ultrasonography

並列摘要

For assessing the value of abdominal ultrasonography in preoperative diagnosis of gallbladder carcinoma, various diagnostic procedures including oral cholecystography (OCG), intravenous cholangiography (IYC), endoscopic retrograde cholangiopancreatography (ERCP), peritoneoscopy and arteriography were compared on 13 surgically proved patients in the past 9 years. Of 13 patients, one belonged to Nevin's classification stage I, one to stage II and eleven to stage IV. Among 5 patients encountered before application of abdominal ultrasonography, only one patient was suspected to have gallbladder carcinoma preoperatively, because of the irregular defect within the lumen of gallbladder and evidence of external compression of common hepatic duct or Mirriz's syndrome in ERCP examination. Of the other 4 patients, the pre-operative diagnosis were cholelithiasis in 2 patients, chronic cholecystitis and colon carcinoma in one patient each. Whereas after using abdominal ultrasound as the initial screen test in 8 patients, a correct preoperative diagnosis of gallbladder carcinoma was made in 7 patients, with only one exception.
In patients with gallbladder carcinoma, the cystic duct is usually obstructed by tumor invasion, chronic cholecystitis and/or cholelithiasis. Therefore, the radiologic cholecystography including OCG, IVC, ERCP and percutaneous transhepatic cholangiography (PTC) almost always fail to visualize the gallbladder whether the patient has jaundice or not. And thus the radiologic cholecystography is very difficult to reach a preoperative diagnosis of gallbladder carcinoma. In contrast, ultrasonography can easily demonstrate the tumor within the gallbadder regardless of the function of gallbladder or the patency of cystic duct. Up to the present, this is the simplest and the most effective pre-operative diagnostic procedure for gallbladder carcinoma.