高脂餐试验B超诊断胆总管囊肿一例

患者,女,34岁。因上腹部隐痛不适3年余就诊。初查B超发现在胆囊、胰头、肝脏之间有一个4.2×4.6cm之囊肿样回声,肝内胆管无明显扩张,胰头部胆管无明显改变。初步印象为胆总管囊肿,不排除肝囊肿、肠系膜囊肿及胰腺假性囊肿。为进一步明确诊断嘱患者高脂餐后复查。     

超声诊断先天性胆管囊肿及其癌变的价值

目的 探讨超声诊断先天性胆管囊肿及其癌变的临床价值。方法 先天性胆管囊肿22例，男10例，女12例。超声检查观察囊肿的部位、大小、形态、合并炎症、结石与癌变等情况，并与手术病理检查结果进行对比研究。结果 超声检查诊断为先天性胆管囊肿22例，其中肝外型胆管囊肿54．5％(12／22)、混合型胆管囊肿45．5％(10／22)。其中单纯囊肿22．7％(5／22)，囊肿合并炎症77．3％(17／22)，合并结石54．5％(12／22)，癌变22．7％(5／22)。与手术病理对照，结果 除1例超声诊断为先天性胆总管囊肿而手术证实为肝总管囊肿，其部位略有差异外，其余全部符合。结论 超声检查不仅是诊断先天性胆管囊肿的可靠方法，而且对明确囊肿有无合并炎症、结石，特别是癌变，有重要的临床实用价值。     

B超诊断先天性胆总管胰管扩张1例

患者男,７０岁。以上腹疼痛２０余天住院。一般情况可,心肺正常。上腹偏右压痛。肝功及黄疸指数正常。胃镜诊断为十二指肠炎,经治疗,疼痛不能缓解。Ｂ超检查：与门静脉并行的胆总管呈囊状扩张,其头侧端与肝内胆管相通,而肝内胆管无扩张。囊肿的上方为胆囊,胆囊大小...     

B超诊断胆囊囊肿并结石一例

患者 ,女性 ,42岁。反复上腹疼痛三年。曾以胃病治疗症状缓解。近日疼痛复发。症状加重。仍按胃病处理无效而行Ｂ超检查。Ｂ超所见 :胆囊形态欠正常。体积增大约 81.5ｍｍ× 3 5ｍｍ ,壁明显增厚 ,约 6.5ｍｍ ,且毛糙 ,囊颈部见 11.5ｍｍ×7.3ｍｍ强光团 ,后方伴声影。于囊底前上方见向外突出一 2 1.3ｍｍ× 11.9ｍｍ囊性肿块 ,壁规则光滑 ,厚 3ｍｍ ,与胆囊不相通 ,囊内可见两个 7ｍｍ、8ｍｍ大小强光团 ,后方伴声影 (图 1)。肝内外胆管不扩张。Ｂ超诊断 :①慢性胆囊炎。②胆囊结石。③胆囊囊肿并多发性结石。经手术而证实超声诊断。讨论 :…     

B超诊断先天性胆总管囊肿一例

患者女性 ,15岁。因右上腹疼痛并呕吐二月 ,加重 8ｄ入院。体检 :一般情况好 ,于肋下 3ｃｍ腹直肌外侧处可触到一大小约 3.0ｃｍ× 4.0ｃｍ的包块。质硬 ,活动度不佳。Ｂ超检查 :应用ＡｌｏｋａＳＳＤ -110 0型Ｂ超仪 ,探头频率 3.5ＭＨｚ。于右第 6肋间横向扫查 ,见第一肝门胆囊后方有大小约 4.3ｃｍ× 3.9ｃｍ无回声区 ,形态规则、囊壁清晰 ,仔细扫查可见囊肿与两端的肝管相连 ,囊肿后壁回声增强 (图 1)。Ｂ超诊断 :胆总管囊肿。手术所见 :于胆总管、十二脂肠上段见一囊肿 ,大小约 6.0ｃｍ×8.0ｃｍ ,与周围组织无粘连。讨论 :先天性胆管…     

B超诊断肝内胆囊伴胆囊炎1例

Ｂ超诊断肝内胆囊伴胆囊炎１例河北省南皮县医院韩彬，岳文雅患者男性，４３岁。因近一个月肝区及腰背部隐痛且逐渐加重来诊。临床上怀疑为胆石症、脸囊炎而行肝胆Ｂ超检查。超声所见：肝脏大小形态正常，肝内血管走行清晰，肝内外胆管不扩张。在正常胆囊部位均未见到胆囊...     

改进操作技术以提高B超对肝外胆管结石诊断的准确率

改进操作技术以提高Ｂ超对肝外胆管结石诊断的准确率邮政编码４１９３００湖南省溆浦县人民医院向延常为提高Ｂ超对肝外胆管结石的诊断符合率，我们不断改进操作技术，使肝外胆管中下段及其结石得到较满意的显示。现将经手术治疗的肝外肝管结石３０例的Ｂ超检查结果报告如...     

B超诊断多发性膀胱憩室合并结石1例

Ｂ超诊断多发性膀胱憩室合并结石１例马鞍山市马钢总公司医院Ｂ超室赵洁患者男６０岁，尿线变细，排尿无力多年，首次Ｂ超诊断为膀胱残室合并结石，前列腺增生。复查Ｂ超提示为多发憩定合并结石，前列腺增生。Ｘ光平片显示与Ｂ超相符，但未见阳性结石影，手术与病理均证实...     

先天性胆管囊肿合并胆道肿瘤的CT表现

目的报道15例少见的胆管囊肿合并胆道肿瘤的病例,旨在提高对本病的认识。方法回顾性分析手术、穿刺病理证实的15例胆管囊肿合并胆管胆囊癌病例的临床和CT资料,对其临床表现、影像学检查进行分析,并对其病因、病理及诊断进行讨论。结果胆管囊肿Ⅰ型9例,Ⅳ型5例,Ⅴ型1例。胆总管囊肿Ⅰ型常见,合并胆管胆囊癌占60%(9/15)。15个病例中,以肿块表现为主者6例,以胆管胆囊壁增厚为主者9例。CT增强扫描出现延迟相强化者13例,占86.67(13/15)。CT诊断胆管囊肿合并胆道肿瘤的准确性86.67%(13/15)。结论CT是诊断胆管囊肿合并胆道肿瘤的一种有价值的、无损伤的手段。     

先天性胆管囊肿的诊断与治疗

目的：探讨先天性胆管囊肿的诊断与治疗方法。方法：回顾性总结分析1987年1月—2000年12月我院收治的先天性胆管囊肿114例。结果：发现先天性胆管囊肿临床表现具有典型胆管囊肿三联征者少，仅20．2％；合并病变发生率高．达90例(78．9％)，包括胆管炎18例、胆结石34例、胆汁性肝硬变22例、胆道癌变12例、胆囊腺瘤1例、胆道穿孔1例、急性胰腺炎2例，是病情加重的主要原因；胆管囊肿切除、肝总管空肠Roux—Y吻合术后并发症较少、效果良好。结论：认为早期诊断、早日手术、彻底切除囊肿，是减少合并病变发生、提高治愈率的关键。     

Causes of biliary sludge

AIM: To specify characteristics of biochemical bile composition contributing to destabilization of colloid properties of bile in patients with biliary "sludge". MATERIAL AND METHODS: 37 patients with "sludge" in the gallbladder (GB), 10 patients with cholelithiasis and 10 patients with intact GB participating in the study were examined for bile portion B bile acids (BA), cholesterol and phospholipids (PL); lipid and lipoprotein blood composition. RESULTS: Three types of biochemical composition of bile in GB "sludge" patients were identified. 22 patients had elevated levels of cholesterol and PL in subnormal content of BA (group 1); 9 patients had normal FA and cholesterol, low content of biliary PL (group 2); 6 patients had normal concentrations of the three components (group 3). Blood lipids were characterized by elevated levels of total cholesterol and LDLP cholesterol in group 1; low HDLP cholesterol and triglycerides in group 2 and almost normal values in group 3. Basing on these data, causes of "sludge" formation in the GB are suggested. CONCLUSION: Biliary "sludge" may form because of excessive cholesterol in bile, low phospholipid levels or in normal proportion of the studied substances.     

B超对恶性肝门部胆管梗阻应用经皮经肝自膨式金属内支架疗效的评价

本文对１６例恶性肝门部胆管梗阻（ＭＨＢＯ）在超声引导下采用经皮经肝自膨式金属内支架（ＥＭＢＥ）治疗结果表明：①超声引导下行ＥＭＢＥ可避开肝内血管，且不受扩张胆管内径大小及走行方向的影响，一次性成功率高，负损伤小。②用Ｂ超监测肝内胆管径可观察胆管开通状况，作为衡量减黄效果的重要指标。③ＥＭＢＥ早期合并症少，术后生存期长，如加用放射疗法，可大大提高生存期。     

三维磁共振胰胆管成像诊断婴儿胆道闭锁

目的 分析3D-MRCP对婴幼儿胆道闭锁的诊断价值。 方法 收集13例临床怀疑为胆道闭锁的患儿,所有患儿均接受3D-MRCP检查,根据MRI诊断结果,选择术中造影、腹腔镜探查或病理检查。对比分析所有患儿的3D-MRCP与术中造影、腹腔镜探查及手术病理所见。结果 MRI诊断胆道闭锁10例,胆总管囊肿2例,1例正常;术中造影诊断胆道闭锁6例、胆道狭窄1例,显影正常1例;腹腔镜诊断胆道闭锁2例;手术病理诊断为先天性胆总管囊肿2例;另有1例患儿经临床治疗后痊愈。结论 3D-MRCP可在术前有效诊断BA。如经3D-MRCP多方位观察,仍未发现完整的肝外胆道,应高度怀疑胆道闭锁。     

Influence of surgical biliary pathology on the diffusion of ceftriaxone in the biliary tract

Ceftriaxone is a third generation cephalosporin remarkable for its wide distribution in the biliary tract. The purpose of this study was to determine whether biliary tract pathology, as observed during surgery, had an influence on this distribution. 52 patients about to be operated upon and presenting with a high risk of bile infection received a single 1 or 2 g dose of ceftriaxone administered intravenously over 20 min during the hour that preceded surgery. Samples of blood and of bile from the gallbladder (GB) and the common bile duct (CBD), as well as specimens of the GB wall were taken during the operation. In patients whose GB was normal at laparotomy (apart from stones) ceftriaxone concentrations in bile and GB wall were 10-25 and 2 times respectively higher than in plasma. In patients with a grossly distended but not infected GB (hydrocholecystis) ceftriaxone levels were high in CBD bile but null in GB bile and only one-quarter to one-half of plasma levels in GB wall. In patients with stones in the CBD or inflamed GB wall ceftriaxone levels were high in bile (although lower than in cases with normal GB) and similar to plasma levels in GB wall. When malignant pancreatic lesions were present ceftriaxone concentrations could not be measured in both GB and CBD bile but reached 50% of plasma concentrations in GB wall.(ABSTRACT TRUNCATED AT 250 WORDS)     

胆道疾病的影像检查(附486例报告)

目的 评价各种影像检查方法在胆道疾病诊断中的价值。方法 回顾性复习486例经手术病理证实的胆道疾病影像资料,分析各检查方法的优势和局限性。结果 26例胆囊内阴性结石在传统造影中显示清楚。胆道直接造影能清楚显示胆道解剖形态及病因。B超和CT对胆道结石诊断阳性准确率为91.3%和90.3%,13例泥沙样胆石CT漏诊。超声诊断慢性胆囊炎和胆囊息肉符合率达100％和93.3%。MRCP的“胆管树”有助于肝门胆管癌的确诊。结论 传统造影法能较好显示胆囊阴性结石,胆道直接造影为定性诊断提供重要依据。B超和CT显示胆道结石优于其他方法。超声是慢性胆囊炎和息肉样病变最好检查方法。MRCP是诊断重度胆道梗阻的理想影像手段。     

超声对恶性肝门部胆管梗阻应用经皮经肝自膨式金属内支架疗效的评价

目的：评价超声对恶性肝门部胆管梗阻（MHBO）应用经皮肝自膨式金属内支架（EMBE）的疗效。方法：对30例恶性肝门部胆管梗阻患者在超声引导下采用经皮经肝自膨式金属内支架。结果：在超声引导下采用（EMBE），可避开肝内血管，且不受扩张胆管内径大小及走行方向的影响，一次性成功率高，负损伤小。结论：用超声监测肝内胆管径可观察胆管开通状况，作为衡量减黄效果的重要指标。EMBE早期合并症少，术后生存期长，如加用放射疗法，可大大提高生存期。     

巨细胞病毒相关性胆道闭锁患儿临床特征分析

摘 要：目的:描述中国胆道闭锁（BA）患儿巨细胞病毒（CMV）感染的流行情况，分析CMV IgM阳性和CMV IgM阴性胆道闭锁的临床特点。方法: 纳入2007年3月至2021年12月，在上海交通大学医学院附属新华医院接受Kasai手术治疗的281例胆道闭锁患儿，收集BA患儿的基本资料和临床资料，包括年龄、性别、出生月份、CMV感染情况和肝脏生化指标等，回顾性分析BA患儿CMV感染的情况，比较CMV IgM阳性与CMV IgM阴性BA患者之间的临床差异。结果: 281例BA患儿中，CMV IgM阳性患儿106例占37.72%；CMV IgM阳性患儿的手术时年龄（72.5（63-86）天）显著大于CMV IgM阴性患儿（59（47-69）天；P < 0.0001）。11月份出生的CMV IgM阳性患儿例数显著多于CMV IgM阴性患儿（13.21% vs. 5.71% ; P = 0.0294）。CMV IgM阳性BA患儿出生于冬季（11月～1月）的发病率是夏季（6～8月）的1.6倍，但无统计学差异。单因素分析结果提示，CMV IgM阳性BA患儿的胆汁酸、天冬氨酸氨基转移酶、碱性磷酸酶、总胆红素和直接胆红素水平高于CMV IgM阴性BA患者，差异均有统计学意义（P < 0.05）。CMV IgM值与与各项生化指标无线性相关关系。结论: 中国BA患儿CMV IgM阳性率为37.72%，出生于11月最常见，但无季节性聚集；相比CMV IgM阴性BA，CMV IgM阳性BA患儿手术时年龄更大，胆汁酸、天冬氨酸氨基转移酶、碱性磷酸酶、总胆红素和直接胆红素水平更高。     

Choledochal cyst due to anomalous pancreatobiliary junction in the adult: sonographic findings

Background: Adult cases of choledochal cyst due to anomalous pancreaticobiliary duct junction have been rarely reported. At present, sonography (US) is the first tool for diagnosing biliary disorders. The aim of this study was to reevaluate the US findings of choledochal cysts due to anomalous pancreaticobiliary duct junction in adults. Methods: We reviewed the clinical manifestations and US findings of 12 such adult cases confirmed by endoscopic retrograde cholangiopancreatic ductography (ERCP). Patients were assigned to three groups: (a) associated with biliary carcinoma (two cases), (b) associated with choledocholithiasis (one case), and (c) not associated with other abdominal diseases (nine cases). Results: Patients in group c were asymptomatic, and the lesions were detected incidentally detected by US. In contrast, patients in group a sought medical care because of symptoms such as jaundice and those in group b sought medical attention because of abdominal pain. The diameter of a dilated bile duct on US was considerably less than that of ERCP (ERCP: 26–58 mm, mean = 37.6 mm; US: 13–32 mm, mean = 21.8 mm). Its diameter changed significantly under probe compression when the dilated bile duct took a purely cystic form but changed very little when it took a tubular form. Conclusion: Unlike cases in children, adult cases of choledochal cyst are generally asymptomatic. Careful US observation of the bile duct is thus expected to detect asymptomatic adult choledochal cysts cases. Cyst diameter can change significantly under probe compression, so it is important not to compress the bile duct during routine US examination. Received: 13 September 2000/Accepted: 18 October 2000     

Reconstruction of intrahepatic bile ducts in congenital biliary atresia.

Macroserial reconstruction of the main intralobular bile ducts was made in 7 cases of biliary atresia; 2 cases of type I, 1 case of type II and 4 cases of type III according to Kasai's classification. From the results of these reconstruction studies, it was confirmed that the main interlobular bile ducts are usually patent through the liver regardless of the type of atresia of the extrahepatic bile ducts. A microserial reconstruction of bile ducts and ductules of a small portal tract performed in one case disclosed that a number of ductules make a network around the main duct and have some communications with the main duct. These results were compatible with the fact that active excretion of bile was obtained in many postoperative patients with biliary atresia. As observed in one case of the present series, postoperative complication of severe ascending cholangitis seemed to be an important cause of destruction or disappearance of intrahepatic bile ducts, which has also seen in older infants with this disease without complicaion of cholangitis. In view of these facts the operation of an early stage of life is recommended in biliary atresia.     

评价超声与磁共振胰胆管成像诊断胆系疾患的价值

目的探讨超声(US)及磁共振胰胆管成像(MRCP)技术在胆系疾病中的诊断价值。方法87例胆系疾病患者行US及MRCP检查,结果应用SPSS10.0进行接受器工作特性曲线(ROC)分析,所有病例经内窥镜逆行胰胆管造影(ERCP)或手术证实。结果对于胆囊及肝内胆管疾患,US及MRCP的ROC曲线下的面积相近,无明显差异(P=0.326;P=1.000);而对于胆总管疾患,MRCP的ROC曲线下面积大于US曲线下面积,具有差异显著性(P=0.034)。结论MRCP与US在诊断胆囊及肝内胆管疾患方面具有同样高的诊断价值,而在诊断胆总管疾患方面MRCP的价值优于US。