术中胆道造影胆总管阻塞征象的研究

目的探索术中胆道造影中出现的假性胆总管阻塞征(简称假性阻塞)X线征象，减少误诊。材料与方法搜集整理200例术中胆道造影，其中男性72例女性128例，年龄为23～84岁，手术时胆囊切除经胆囊管注入造影剂，造影剂为60％胆影葡胺或12．5％碘化钠溶液10～20ml。结果本组出现假性阻塞55例占27．5％。X线表现常能鉴别假性阻塞与真性阻塞，假性阻塞表现为阻塞远端钝圆、有柔软感，而不象真性阻塞的远端有僵直感。如胆总管括约肌痉挛时，可向胆总管内注入1％普鲁卡因5ml，使痉挛缓解。结论熟悉术中胆道造影胆总管假性阻塞与真性阻塞X线征象十分重要否则会误诊。

Study of obstruction sign of the common bile duct in operative cholangiography

Purposes The purpose is for correct differential diagnoses of pseudoobstruction(POS) and real obstruction of the common bile duct.Materials and methods 200 cases are collected. Male 72 cases, female 128 cases. The age ranged for 23 to 84 years. During operation,a thin tube is inserted into the common bile duct or via the cystic duct postcholecystectomy. The bile system is filled with 10 - 20ml of 60% Biligrafin of 12. 5% sodium iodide solution.The X- ray film is exposed after injection. Results In this group,POS was found in 55 cases(27. 5% ). POS shows regular,round form and soft feeling of distal end of the common bile duct with no special pathologic form and rigidity of distal end in real obstruction. If persistent spasm of sphincter choledochus is present, serialo- graphic views of the distal common duct are taken following the introduction of 5ml of 1 % procaine before X- ray exposure in or der to relax spasm. So,obstruction sign immediately disappear. Conclusion It is of importance to determine POS or real obstruction in the distal portion of the common bile duct. The wrong diagnosis is often be made in operative cholangiogram,if we have no such ex periences.