十二指肠乳头旁憩室综合征影像学诊断价值的研究

目的　研究十二指肠乳头旁憩室 (PAD)综合征的影像学表现。对PAD进行分型和临床分级 ,提出合理的影像检查流程 ,以提高放射医师及临床医师对PAD综合征的影像诊断水平。资料与方法　回顾性分析经内镜证实的 117例PAD患者的临床及影像资料 ,分析PAD与胆胰管末端的位置关系。结果　 117例中显示 119个PAD ,其中乳头上型 71个 ,乳头下型 17个 ;乳头开口于憩室内 (憩室内型 ) 10个 ,乳头开口于憩室边缘 (憩室缘型 ) 2 1个。以憩室内型、边缘型和乳头上型易引起胆胰系统症状。合并肝外胆管扩张者 (直径 >1.0cm) 77例 (占 6 5 .8% ) ,相应PAD直径明显大于胆总管不扩张者 (P <0 .0 1)。结论　ERCP结合PAD造影及MRCP都是显示PAD及其与胆总管下段解剖关系的有效的影像检查手段 ,是诊断PAD综合征的理想方法 ,值得临床推广应用

Evaluation of Imaging Examinations in Diagnosing Periampullary Diverticula of Duodenum

Objective To study the imaging manifestations of the periampullary diverticula of the duodenum, so-called Lemmel's syndrome, to work out a reasonable algorithm of imaging examination and to improve the clinical diagnosis of the disease.Materials and Methods Clinical materials and imaging findings of 117 patients with endoscopically-proved periampullary diverticula of the duodenum were retrospectively analyzed. The imaging observation was focused on the anatomic relation of the diverticulum with the terminal segment of pancreaticobiliary duct.Results In 117 patients, 119 periampullary diverticula were detected. Based on the anatomic relationship of the diverticulum with the papillary orifice, the total of 119 periampullary diverticula could be divided into four types. (1) The supra-papillary type (n=71). (2) The infra-papillary type (n=17). (3) The intra-diverticular type (n=10) with the papillary orifice being inside the diverticulum. (4) The marginal type (n=21), with the papillary orifice being at the edge of the diverticulum. Patients with supra-papillary, intra-diverticular or marginal type of periampullary diverticulum, were liable to develop pancreaticobiliary symptoms. Accompanied extra-hepatic cholangiectasis (biliary duct diameter >1.0 cm) was found in 77 cases (65.8%), in those patients the diverticular diameter was significantly larger than that in the patients showing no extra-hepatic cholangiectasis (P<0.01).Conclusion Both ERCP with duodenography and MRCP are effective imaging examinations for displaying periampullary diverticula and its anatomic relation with the terminal segment of pancreaticobiliary duct. It is worth using in the diagnosis of periampullary diverticula.