目的评价16层螺旋CT三期增强后三维重建在确定胆囊癌的CT分期和评价手术可切除性的价值。方法27例临床和超声检查怀疑胆囊癌的病例,前膽性分析其16层螺旋CT三期增强表现,其中20例做了胆囊癌根治性切除术或姑息手术的患者。三维容积重建评价血管的解剖及受侵犯情况,CT分期及可切除性评价与手术结果对照。结果根据CT表现,8例肿瘤可切除,12例不能切除。术中发现11例肿瘤可切除,9例不能切除,3例CT分期过高,认为不能切除的病例是由于CT误诊十二指肠受浸润。在评价胆囊癌可切除性方面,CT的敏感性为72.7%(8/11),特异性为100%,准确性为85%(17/20),在肝脏和血管受侵犯方面和CT评价和手术所见完全一致,接受根治性胆囊癌切除的患者中发现6例血管变异。结论三期增强螺旋CT三维重建是一种可靠的分期胆囊癌的影像方法,术前可确定血管的走行路径。 Objective To evaluate the value of three-dimensional enhanced three-phase reconstruction of 16-slice spiral CT in determining the CT staging of gallbladder carcinoma and evaluating the resectability. Methods Twenty - seven cases of gallbladder carcinoma suspected by clinical or ultrasonography were examined retrospectively. The 16 cases with enhanced gallbladder carcinoma by three - phase spiral CT were analyzed retrospectively. Twenty patients underwent radical gastrectomy or palliative surgery. Three-dimensional volume reconstruction was used to evaluate the anatomy and invasion of blood vessels. CT staging and resectability were compared with surgical findings. Results According to CT findings, 8 cases were resectable and 12 cases could not be resected. Intraoperative findings 11 cases of resectable tumors, 9 cases can not be removed, 3 cases of CT staging is too high, that can not be removed due to CT misdiagnosis of duodenal infiltration. In evaluating the resectability of gallbladder carcinoma, the sensitivity of CT was 72.7% (8/11), the specificity was 100% and the accuracy was 85% (17/20). CT and CT evaluation in terms of liver and vascular invasion Surgery see exactly the same, received radical resection of gallbladder cancer patients found in 6 cases of vascular variability. Conclusion Three-phase enhanced three-dimensional reconstruction of spiral CT is a reliable imaging method for staging gallbladder carcinoma. The path of blood vessels can be determined preoperatively.