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1.
目的 探讨小儿先天性胆管囊肿的CT诊断及鉴别诊断。方法 对21例经手术和/或病理证实的资料完整的小儿胆管囊肿病例进行回顾性分析。结果 21例先天性胆管囊肿的CT表现如下:(1)单纯胆总管囊性扩张13例,表现为肝门区或胰头区附近圆形的水样密度灶,增强囊内无变化。(2)肝内胆管多发囊性扩张2例,表现为肝内多个囊并且太,梭状低密度灶,增强后,可见其内有中心点状及树枝状明显强化灶。(3)肝内外胆管多发囊性扩张6例,同时具有以上两种征象,本病需与胰头囊肿,右肾囊肿,肠系膜囊肿,肝内单发或多发囊肿,梗阻性肝内胆管扩张等病鉴别。结论 CT是诊断小儿先天性胆管囊肿的重要方法。  相似文献   

2.
本文对25例先天性胆管囊状扩张症根据CT表现分为三种类型:1)肝内型;2)肝外型;3)混合型。肝内型具有特征性CT表现为扩张呈囊状的胆管将门静脉分支包绕,在增强CT或胆道造影CT均可显示出“中心圆点。征象。肝外型囊壁见突出腔内结节时为癌变征象。CT对本病的显示准确率达100%。对照其它影像检查方法,作者认为:超声对本病也有重要诊断价值;X线胆道造影诊断价值不大;ERCP和PTC为痛苦性检查方法,提  相似文献   

3.
目的:探讨CT对肝门部胆管癌诊断的价值。方法:回顾分析33例经病理证实的肝门部胆管癌CT平扫和增强的征像,并与手术所见对照。结果:CT表现肝内胆管扩张31例;肝门区显示肿块14例,平扫肿块密度低于肝脏密度,增强扫描肿块密度有不同程度强化。4例胆管壁呈环状不规则增厚、强化。延迟扫描5例肿块密度与肝密度相似。CT诊断定位准确率88%,定性准确率64%。结论:CT是诊断肝门部胆管癌的重要手段之一,增强延迟扫描可提高定性诊断的准确率。  相似文献   

4.
目的:探讨低张增强扫描技术在梗阻性黄疸诊断中的临床应用价值。材料与方法:选取梗阻性黄疸患者43例行低张增强扫描,以肝内外胆管扩张的范围,形态及病理手术结果作为分组依据,进行统计学处理;另外随意选取32例患者行普通增强扫描,比较两种扫描在诊断上的符合率。结果:1、肝外胆管远段梗阻(P<0.05)、梗阻部呈漏斗样改变(P<0.01),肝内胆管呈竹节样扩张对良性病变诊断有重要意义;肝外胆管中、近段梗阻(P<0.05),梗阻部胆管呈截断型或突然狭窄型(P<0.01),肝内胆管呈软藤状扩张(P<0.01)高度提示恶性病变。2、低张增强扫描技术在诊断上的符合率高于普通增强扫描,尤其在恶性诊断符合率是(P<0.05)。结论:低张增强扫描技术可明显提高梗阻性黄疸的定位、定性诊断的准确率,可在临床上进一步推广。  相似文献   

5.
目的探讨肝内胆管结石的CT表现及诊断价值。方法对26例肝内胆管结石患者进行常规1次屏气螺旋CT扫描,并分析其CT征象。结果(1)CT诊断肝内胆管结石的准确率达92.3%:(2)根据密度不同,结石分为高密度、等密度、低密度结石:(3)常伴有胆内胆管的柱状、囊状扩张;(4)CT可准确显示其并发症。结论CT对肝内胆管结石及其并发症有较好的诊断价值。  相似文献   

6.
MRI及MRCP在先天性胆管囊肿及合并症中的诊断价值   总被引:1,自引:0,他引:1  
目的探讨磁共振成像(MRI)及磁共振胆胰管成像(MPCP)对先天性胆管囊肿及其合并症的诊断价值。方法回顾性分析29例经病理证实的先天性胆管囊肿患者的MRI及MRCP影像表现。结果29例先天性胆管囊肿,10例Ib型,7例Ic型表现为仅限于胆总管局限性扩张,MRCP示扩张胆总管与胆管树相通。10例IV型,2例V型表现为肝外和/或肝内及仅限于肝内多发胆管扩张,MRCP示胆管树呈多发大小不等囊柱状。合并结石7例,Ib型4例,IV型3例,表现为胆管内单发和/或多发边界清楚无强化灶。合并肿瘤3例,IV型及V型合并胆管癌各1例,表现为扩张胆管壁内强化结节;1例Ib型合并胆囊癌伴肝内多发转移。1例V型合并闭锁表现为扩张胆总管远端中断。1例VI型合并胰腺炎。MRI及MRCP能准确地做出胆管囊肿的诊断并能进行准确的分型,定位,定位准确率达100%,并能清楚显示胆管囊肿的合并症。结论MRI及MRCP检查在先天性胆管囊肿的诊断及显示其合并症中具有重要的价值。  相似文献   

7.
目的:探讨先天性胆管囊肿的外科治疗。方法:对我院11年中21例胆管囊肿病人进行回顾性分析。结果:肝外胆管囊肿20例中,行囊肿空肠或十二指肠吻合术者6例,外引流术2例,囊肿切除,肝总管空肠Roux-Y吻合术12例,肝内胆管囊肿1例,全组均行手术治疗。总优良率达80.06%。行囊肿切除,肝总管空肠吻合术优良率达92.30%。结论:肝外胆管囊肿应首选囊肿切除,肝总管空肠Roux-Y吻合术,对于肝内囊肿应根据情况进行相应肝或肝段切除。再行肝总管空肠Roux-Y吻合术。  相似文献   

8.
目的:探讨16排螺旋CT三期扫描肝内胆管细胞癌的CT表现,尤其是少见病例的CT特征性表现。方法:对手术病理证实的46例肝内胆管细胞癌的临床资料,CT片进行回顾性分析、总结。结果:本组中41例为乏血供,增强扫描从始至终未见强化,5例为富血供肿瘤,增强扫描病灶有环形强化。结论:肝内胆管细胞癌CT三期扫描有一定特征性的表现,尤其是富血供肿瘤,对其CT的表现与病理对照,有助于提高CT诊断的准确性,减少误诊。  相似文献   

9.
目的:探讨肝内胆管乳头状瘤(Intrahepatic biliary papillomatosis,IHBP)的临床病理特征、影像学表现。方法 :回顾性分析5例经手术病理证实的IHBP患者的临床病理特征及影像学表现,并结合文献进行分析和讨论。结果:5例IHBP患者中2例表现为间歇性黄疸、1例腹痛伴发热、1例左腰背部酸痛,1例体检时发现。影像学特点:5例均发现全胆管树系统扩张,胆总管下段无明确占位或结石,受累肝内胆管相对比另一肝叶胆管或胆总管不成比例的扩张,受累肝内胆管呈"瘤样"扩张,扩张的肝内胆管出现乳头状或长条状肿块影,MRCP示扩张胆管内多发乳头状及条状充盈缺损,3例位于右肝内胆管、2例位于左肝内胆管,肿块直径约0.3~2.5 cm,于CT平扫呈等或稍低密度,MR T1WI表现为等或稍低信号,T2WI上多呈等高信号,DWI上呈乳头状及条状高信号,增强扫描肿块呈轻度强化。结论:IHBP的影像学表现有一定的特征性,尤其MRCP、DWI及动态增强检查,熟悉该病的特征性影像学表现有助于对IHBP诊断及鉴别诊断。  相似文献   

10.
目的 探讨成人胆管囊肿及其合并症的超声、核磁及胰胆管水成像 (MR/ MRCP)的影像表现。方法 选取胆管扩张病例进行超声及核磁检查 ,观察胆胰管内径、胆管扩张形态、管壁厚度、回声 ,并进行彩色多普勒血流检测及核磁胰胆管水成像 (MR/ MRCP)检查 ,两者结果与术后病理对照。结果 经手术证实胆管囊肿 2 0例 ,包括 :Caroli's病 2例 , 型胆总管囊肿 14例 ,呈囊性、梭形、圆柱形扩张 ;肝门部胆管囊肿 (囊肿型 ) 3例 ,胆总管上段憩室 1例 ( 型 )。合并胆囊结石 10例 ,肝内胆管、胆总管结石 8例 ;合并肝局灶性炎 3例 ,肝脓肿 1例 ;合并癌变 5例 (高、低分化腺癌 3例 ,黏液腺癌 1例 ,类癌 1例 ) ;共同管过长 (>1.5 cm) 6例。超声与 MRCP对胆管囊肿全部诊断。合并症中超声对炎变、结石、癌变诊断分别为 95 % ,10 0 % ,95 % ,而 MRCP/MR为 10 0 % ,90 % ,95 %。超声对结石、癌变及管壁的微细结构观察优于 MRCP,MRCP对胆管全程显示优于超声 ,结合平扫及增强扫描诊断炎变符合率 10 0 %。结论 超声与 MR成像在成人胆管囊肿及其合并症中的诊断意义重大 ,联合应用有利于对该病的全面认识 ,便于指导临床。  相似文献   

11.
梗阻性黄疸的CT和ERCP诊断   总被引:6,自引:0,他引:6  
目的 通过分析梗阻性黄疸的CT和ERCP表现,总结出有意义的征象,以提高本病的诊断水平。方法 回顾性分析经病理证实的梗阻性黄疸病例的ERCP(68例)及CT(45例)表现。结果 良性梗阻性黄疸一般表现为胆总管扩张较轻,肝内胆管呈枯枝状,胆总管由上至下逐渐变细;恶性者则一般表现为胆管中-重度扩张,肝内胆管如软藤状,扩张的胆管由上至下突然中断。结论 CT和ERCP均能对梗阻性黄疸作出较准确的定位及定性诊断,但互有长短,疑胆总管下端梗阻时联合运用两种检查方法,可提高诊断准确率。  相似文献   

12.
A rare case of choledochal cyst complicated by papillary adenocarcinoma in the cystically dilated intrahepatic bile duct is reported. The tumor was located in the neck of the cystic lesion, and imaging modalities failed to show communication between the cystic lesion and the bile ducts. Received: 20 November 1995/Accepted: 11 January 1996  相似文献   

13.
目的 探讨Caroli病的64排螺旋CT表现及诊断价值.方法 对经手术病理证实的15例Caroli病的64排螺旋CT影像资料进行回顾性分析.结果 所有病例CT均表现为肝内多发囊状或条状低密度影,与肝内胆管相通,增强扫描无强化,其中4例可见"中心圆点征".Caroli病I型12例,其中2例合并肝内多发血管瘤及肝内多发小囊肿,4例在扩张的胆管内见结石并3例见有胆管积气,1例合并胆管炎改变,其余5例仅发现肝内胆管扩张.Caroli病II型3例,其中2例伴有肝硬化;1例合并肝内小胆管炎及门静脉周围纤维化.结论 64排螺旋CT三维重建的应用,可以多方位、多角度全面观察肝内多发囊性病变的分布及与肝内胆管分支的关系,对Caroli病的诊断、鉴别诊断及明确病变范围有重要价值.  相似文献   

14.
Siegel EG  Fölsch UR 《Endoscopy》1999,31(2):200-203
A choledochal cyst type I was diagnosed in a 12-year-old boy in 1984. The diagnosis was made using ultrasound and confirmed using computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP). Instead of the usual surgical treatment, endoscopic balloon dilatation of the sphincter of Oddi and the distal common bile duct was carried out using an endoscopic procedure. The patient experienced relief of symptoms, gained weight and felt healthy again. An ERCP performed in 1990, because of increasing levels of liver enzymes and clinical features of abdominal pain and fatigue, revealed typical cholangiographic findings associated with primary sclerosing cholangitis, including bile duct irregularities with diffuse narrowing and twisting of the bile ducts with localized ectatic and strictured areas. Percutaneous needle liver biopsy confirmed the diagnosis. We conclude that primary sclerosing cholangitis should be considered when interpreting ERCP films from patients who are supposed to have choledochal cysts type I.  相似文献   

15.
In the past, choledochal cysts had been infrequently diagnosed prior to surgical exploration for obstructive jaundice. However, with the advance of imaging modalities, preoperative diagnosis is usually apparent. We evaluated the radiological findings of choledochal cysts in 14 patients in whom ultrasonography (US) or computed tomography (CT) were mainly used for diagnosis. In addition, oral cholecystography, intravenous (IV) cholangiography, scintigraphy, and percutaneous transhepatic cholangiography were performed in some of them. The diagnosis was confirmed surgically in all patients. Ultrasonographic examinations were diagnostic in 13 of 14 patients. Preoperative specific diagnosis of choledochal cyst was possible with the demonstration of direct entrance of the extrahepatic bile ducts into the cyst in most cases. When US fails to show relation of cystic mass with biliary system, other imaging modalities can be used to clarify the findings.  相似文献   

16.
先天性胆管囊肿的诊断与治疗   总被引:14,自引:0,他引:14  
蒋力生  王挺  彭其芳 《华西医学》2003,18(2):171-172
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。  相似文献   

17.
目的通过与磁共振胆胰管成像(MRCP)对照分析45例先天性胆管扩张症的超声声像图特征及漏诊原因。方法对45例先天性胆管扩张症的超声(US)与MRCP检查结果进行对照分析。结果本组病例超声检查正确诊断率为91.1%。先天性胆管扩张症的超声声像图表现根据胆管扩张形态、累及范围分为:胆总管囊性扩张型(Ⅰ型)(84.4%),肝内、外胆管扩张型(Ⅳ型)(13.3%),肝内胆管囊性扩张型(Ⅴ型)(2.2%)。结论Ⅰ型先天性胆管扩张症因表现为典型超声声像图特征,故其诊断符合率较高(97.4%);Ⅳ型肝内、外胆管轻度不规则扩张及Ⅴ型肝内胆管多发囊性扩张,超声诊断易漏、误诊为肝内、外扩张及肝多发囊肿。  相似文献   

18.
Sharma BC  Agarwal N  Garg S  Kumar R  Sarin SK 《Endoscopy》2006,38(3):249-253
BACKGROUND AND STUDY AIMS: The formation of a communication between liver abscesses or cysts and intrahepatic bile ducts is an uncommon cause of significant bile leak. Surgical management of biliary fistulas is associated with high morbidity and mortality. We performed a prospective study of endoscopic management of this type of biliary fistula. PATIENTS AND METHODS: We studied 26 patients who had either liver abscesses or hepatic cysts that had ruptured into the intrahepatic bile ducts. The presence of a biliary fistula was suspected by jaundice and/or by the appearance of bile in percutaneous drainage effluent from a liver abscess and was confirmed by endoscopic retrograde cholangiopancreatography. Once the route of the fistula between the liver abscess or cyst and the intrahepatic bile duct had been defined by cholangiography, patients underwent treatment by sphincterotomy, and either biliary stenting or nasobiliary drainage. Nasobiliary drains or biliary stents (both 7 Fr) were placed according to standard techniques. Nasobiliary drains were removed when bile leakage stopped and closure of the fistula was confirmed by cholangiography; stents were removed after an interval of 4-6 weeks. RESULTS: Of a total of 525 patients with hepatic abscesses or cysts who were seen over a 5-year period, there were 26 patients who developed a demonstrable communication between liver abscesses (n = 20; 16 amebic, four pyogenic) or hydatid cysts (n = 6) and intrahepatic bile ducts (right intrahepatic bile ducts in 22 patients, left intrahepatic bile ducts in four patients). We performed either sphincterotomy with insertion of a nasobiliary drain (n = 20) or sphincterotomy with biliary stenting (n = 6). The fistulas healed in all patients after a mean time of 4 days (range 2-20 days) after endoscopic treatment. We were able to remove the nasobiliary drainage catheters and stents 6-34 days after their placement. CONCLUSIONS: In this case series, endoscopic therapy appears to be an effective mode of treatment for biliary fistulas complicating liver abscesses and cysts.  相似文献   

19.
Spectrum of biliary disease in childhood   总被引:4,自引:0,他引:4  
Obstructive biliary disease in childhood is not common, but should be considered in the differential diagnosis of a child with jaundice, abdominal pain, or an abdominal mass. We have reviewed the experience at Vanderbilt Children's Hospital from 1970 to 1985, during which 87 children 18 years of age or younger with biliary tract disease were seen. Twelve patients (14%) had congenital disorders including choledochal stenosis, Caroli's disease, choledochal cyst, teratoma of the common hepatic duct and common bile duct, congenital septate biliary tree, and isolated atresia of the distal common bile duct. Thirty patients had neonatal cholestatic syndromes, and 37 had calculous disease of the gallbladder or extrahepatic bile ducts. Three patients had obstruction of the common bile duct caused by fibrosing pancreatitis. Two had sclerosing cholangitis. Obstruction of the common bile duct was caused by metastatic neoplasm in three patients. We discuss principles of diagnosis and management.  相似文献   

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