examination of periampullary cancer, diagnosis of periampullary cancer
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Common examinations for periampullary carcinoma
- Inspection Name Inspection Site Inspection Department Inspection Function
- Percutaneous transhepatic cholangiography gallbladder medicine mainly for obstruction ...
- MRI whole body radiology tumor MRI...
- Duodenal barium meal contrast intestine - duodenal barium meal...
- Stomach barium meal stomach gastrointestinal surgery stomach barium meal there ...
- ERCP Department of Intestinal Pancreas and Gallbladder Digestive Health Under Endoscope Pancreaticobiliary...
- Duodenal drainage fluid general characteristics intestine - through the duodenum...
1. Stool and urine examination
About 85%～100% of patients have persistently positive fecal occult blood test, and most of them have mild anemia
, Urinary bilirubin is positive and urobilinogen is negative.
2. Blood test
The increase in serum bilirubin is mostly 256.5～342μmol/L, alkaline phosphatase, γ-glutamyl transpeptidase, mild to moderate increase in transaminase, carcinoembryonic antigen, CA19-9 and CA125 can all be increased.
3. Inspection of duodenal drainage fluid
The duodenum can drain hemorrhagic or dark brown fluid, its occult blood test is positive, a large number of red blood cells can be seen under microscopy, and cancer cells can be found in 60% to 95% of patients with exfoliated cytology.
4. Gastrointestinal barium meal and duodenal hypotonic radiography
Sometimes it can be seen that there are gallbladder pressure marks on the upper side of the duodenum, and thickened common bile duct pressure marks at the junction of the first and second segments, enlarged duodenal papilla, irregular mucosal disorder or filling defect, pancreatic head In cancer patients, the duodenal circle is enlarged, and the inner wall of the duodenum is "stiff" compressed, deformed or partially obstructed, in the shape of "∑", but the typical manifestations are rare.
5. B-mode ultrasound examination
It shows that the common bile duct or (and) the intrahepatic bile duct is dilated, and the gallbladder is enlarged, but the diagnosis rate of ampullary carcinoma itself is low. This is due to the frequent accumulation of gas in the duodenum and stomach and food cover in this part. Those without aundice can provide clues for early further examination, and those with experience can sometimes observe local cancer masses.
MRI examination is meaningful for the identification of pancreatic head cancer and is helpful in the diagnosis of this disease. It can show the location and outline of the tumor. The appearance of ampullary carcinoma and cholangiocarcinoma on the image is similar. The common bile duct and pancreatic duct can be dilated or only bile duct dilatation. This depends on the growth mode of ampullary carcinoma; when pancreatic head cancer, the head of the pancreas enlarges, has a mass, and the pancreatic duct is dilated, and the ring shadow suddenly interrupts and deforms. There are soft tissue shadows or abnormal signals in the common bile duct.
You can look at the inner wall of the duodenum and the nipple. It can be seen that the nipple is enlarged, irregular, nodular, fragile and easy to bleed. It can be pathologically diagnosed by biopsy. Diagnosis of pancreatic duct stenosis or non-visualization, etc.) are of great help.
8. PTC inspection is better than ERCP
Due to the unevenness of the ampullary papilla, narrowing of the lumen, and blockage, ERCP is often not easy to succeed. PTC can show the expansion of the bile ducts inside and outside the liver, and the common bile duct shows a "V" shape irregular filling defect or occlusion. It is valuable for localization diagnosis and differential diagnosis. PTC has The possibility of complications such as bile leakage and biliary peritonitis should be vigilant.
9. Selective celiac angiography (SCA)
It is beneficial for the diagnosis of pancreatic head cancer. The change in the position of the blood vessel can indirectly determine the location of pancreatic cancer. It is beneficial for the diagnosis of pancreatic head cancer. The change in the location of the blood vessel can indirectly determine the location of the pancreatic cancer.
10. Nuclide inspection can understand the obstruction site
A 75Se-methionine pancreas scan showed a nuclide defect (cold area) in the pancreatic cancer.
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