【摘要】 目的 探讨螺旋CT对胆胰管壶腹部肿瘤的诊断价值。方法 胆胰管壶腹部肿瘤28例，包括胰头癌14例，(其中5例位于胰钩突)，Vater’s壶腹癌8例，胆总管下端癌6例；另胰头区及胆总管下端炎症4例，进行对照分析，全部病例均经手术或病理证实。结果 (1)胆胰管壶腹部肿瘤螺旋CT表现为胰头或钩突增大变形、密度改变及十二指肠内侧壁结节，胆总管壁增厚或下端结节；胰头癌突出表现为胰头增大变形及低密度区；Vater’s壶腹部癌、胆总管下端癌密度相对较高，这与肿瘤的病理结构有关；大部分病例有胆胰管扩张，胆胰管扩张与否依据肿瘤生长的位置而定。(2)胰头区及胆总管下端炎症亦表现为胰头增大，胆胰管扩张，但胰头密度较均匀，与周围结构分界欠清、模糊，胆管积气及扩张胆总管末端逐渐变细，这些可作为与肿瘤的鉴别点。结论 胆胰管壶腹部肿瘤的螺旋CT诊断虽然还有一定困难，但仍不失为一种临床上有效的诊断方法。

    【关键词】 胆胰管壶腹部；癌；炎症；体层摄影术；X线计算机

    On spiral CT diagnostic value to ampulla’s carcinoma at the area of choledochopancreatic duct

    WU Ke-ping,YANG Ming-zheng,LI Xiao-bing.

    Department of CT,Yongzhou People’s Hospital,Yongzhou 425006，China

    【Abstract】 Objective To investigate spiral Ct diagnostic value to ampulla’s carcinoma at the area of choledochopancreatic duct.Methods Spiral CT was operated on 22 patients with abdominal carcinoma at the area of choledochopancreatic duct,including carcinoma of pancreatic head (n=14,5 originated from uncinate process),carcinoma of Vater’s ampulla (n=8),carcinoma of the distal choledochus (n=6). In addition,four cases with inflammation of pancreatic head and distal choledochus were served as contrast and analysis,and all cases had been proved by operation.Results (1) Spiral CT presentation of ampulla’s carcinoma at the area of choledochopancreatic duct included enlarged and deformed pancreatic head and uncinate process,soft-tissue nodes in the internal wall of the duodenum,thickened choledochus with soft-tissue nodes in its distal part. The characteristic presentation was that the mass of the pancreatic head showed hypoattenuation. The carcinoma of Vater’s ampulla and distal common choledochus,because of their pathological structures,displayed relatively high density. Most cases could see that the choledochopancreatic duct dilated,which depended on the tumor site. (2) Inflammation of the pancreatic head and distal choledochus showed enlargement of the head,dilated choledochopancreatic duct,ambiguous demarcated with around structures and air accumulation in the bile duct. The above signs were useful of differentiation with tumors.Conclusion Although there are some difficult in spiral CT diagnosis to ampulla’s carcinoma at the area of choledochopancreatic duct,it is an effective diagnostic method. ......