乏特氏壶腹癌的CT诊断

乏特氏壶腹癌临床较少见,术前诊断颇为困难。现将我院经ＣＴ扫描,并经手术及病理证实的３２例乏特氏壶腹癌,结合临床进行分析,以提高本病的早期诊断及鉴别诊断水平。１资料与方法１１临床资料本组３２例,男２１例,女１１例,年龄３６～７２岁,平均５６７岁。病...     

多层螺旋CT诊断壶腹癌及壶腹周围癌

目的分析壶腹癌及壶腹周围癌多层螺旋CT(MSCT)特征,探讨MSCT对本病的诊断价值.方法回顾性分析经手术病理或经十二指肠胰胆管造影(ERCP)活检确诊的35例壶腹癌或壶腹周围癌患者的CT表现.结果 35例均发现肿瘤,增强扫描肿瘤本身可见不同程度强化,其中16例经图像后处理,35例均清晰显示肿瘤及肿瘤与周围组织、血管的关系.结论 MSCT增强扫描与三维重建技术相结合能清晰地显示壶腹部肿瘤病变及其与周围结构的关系,对于壶腹癌及壶腹周围癌的手术治疗具有重要的指导作用.     

乏特氏壶腹癌的B超诊断

本文报告应用B型超声分段观察扩张胆总管,通过两个扫查平面完整显示胆总管长轴切面的方法,对不同平面的胆总管梗阻进行正确定位,提高了胆总管下端病变的显示率。手术治疗的35例中,超声对胆总管下端病变的显示率81.1%,对乏特氏壶腹癌的诊断正确率71.4%本文介绍了乏特氏壶腹癌的超声表现及其诊断方法:     

老年人乏特氏壶腹周围憩室X线分型及其临床意义

通过对２２例老年人乏特氏壶腹周围憩室的Ｘ线表现和临床特征的研究。提出了Ｘ线分型标准。将其分为五型：乳头旁（Ｉ）型，壶腹（Ⅱ）型，乳头异位（Ⅲ），特殊（Ⅳ），混合（Ⅴ）型。其中Ｉ型最多，Ⅱ，Ⅲ型较少，但与胆胰管疾患关系密切，Ⅳ型主要与消化道出血有关，治疗途径与憩室的类型有关。     

CT低张增强扫描诊断胆总管壶腹癌

目的探讨CT低张增强扫描在诊断胆总管壶腹癌中的应用价值.方法回顾分析15例胆总管壶腹癌,其中男9例,女6例,年龄49～71岁,平均年龄55岁,全部病例均经手术病理证实.采用低张、饮水、增强进行扫描.扫描范围包括右膈顶至十二指肠水平段.结果全部病例均有肝内外胆管扩张,肝内胆管扩张呈软藤状.9例胰头钩突平面可见"双管征",5例可见"双环征",3例可见"半月征",8例在扩张的十二指肠降段可见乳头状软组织结节影.结论低张CT增强扫描在胆总管壶腹癌的诊断和鉴别诊断中很有价值.     

局部切除乏特壶腹癌21例临床分析

目的评价局部切除治疗乏特壶腹部癌的疗效.方法回顾性分析1988年5月～1999年5月间对21例乏特壶腹部癌患者实施局部切除的结果.结果术后并发症发生率为14.2%(3/21).1年和5年生存率分别为85.7%(18/21)和33.3%(6/21).结论局部切除可使部分患者获得根治性切除的结果.其创伤小、恢复快、手术并发症及病死率低,局部切除对高龄、一般情况差、有严重合并症等高危因素存在的早期壶腹癌患者是一种较理想的治疗方法.     

乏特氏壶腹嵌顿结石的内镜处理

本文就９４例因乏特氏壶腹嵌顿结石所致的急腹症实施内镜乳头括约肌切开术（ＥＳＴ），并同时取出嵌顿的结石，或将较大结石松动后送回胆总管内并置入支撑引流导管达到迅速解除梗阻，胆胰管减压，通畅引流的治疗目的进行了，总结。结果８３例（８８．３％）治愈；１１例（１１．７％）平稳渡过急性期后择期手术；２例（２．１％）术后出现并发症，经对症治疗后痊愈。本文仅对ＥＳＴ的优点；乳头括约肌的切开长度；取石时机等问题进行了探讨。     

低张下正常乏特氏壶腹部的螺旋CT研究

目的:分析低张下正常乏特氏(Vater's)壶腹部的螺旋CT表现,为研究壶腹部病变提供重要参照。方法:回顾分析经病理或随访证实的正常壶腹部48例,男性组30例,女性组18例,对其螺旋CT表现进行分析。结果:48例中十二指肠低张效果良好的45例,十二指肠乳头层面十二指肠最大内径为(2.39±0.57)cm,男性组和女性组之间差异无统计学意义。十二指肠乳头显示良好的46例,十二指肠乳头的最大横径为(0.42±0.23)cm,男性组和女性组之间差异无统计学意义。结论:正常壶腹部低张螺旋CT表现为十二指肠扩张良好,十二指肠乳头显示清楚,正常十二指肠乳头可分为半圆型、乳头型和扁平型。     

64层螺旋CT增强扫描对较小壶腹周围癌的诊断价值探讨

目的：探讨64层螺旋CT增强扫描在较小壶腹周围癌诊断中的价值.方法：回顾性分析经本院64层螺旋CT检查同时经手术病理证实的较小壶腹周围癌39例患者的临床和CT影像资料.结果：39例患者中：胰头癌18例、胆总管下端癌9例、壶腹癌12例.多种后处理方法相结合可清楚显示十二指肠壶腹周围部的解剖结构、病灶位置、形状、大小及胰胆管扩张情况.38例CT表现低位胆道梗阻,32例表现胆总管截断征,6例表现胆总管下端不规则偏心性或向心性狭窄;36例表现双管征;病灶全部有不同程度强化,其中不均匀强化18例,实心圆强化15例,环状强化6例.结论：64层螺旋CT增强扫描在较小壶腹周围癌诊断中具有较高的价值,通过多种后处理方法能更加直观显示较小壶腹周围癌的直接和间接征象.     

低张螺旋CT扫描在诊断壶腹癌中的应用

壶腹癌是少见的胃肠道恶性肿瘤犤１犦。尸检发生率为０．２％。近年来其发病率有所上升。由于其手术切除率远高于胰腺、十二指肠肿瘤，预后好，因此壶腹癌的早期诊断非常重要。自２０００年１月～２００１年１２月采用低张螺旋CT增强扫描研究壶腹癌病变，积累了一些经验，现报告如下。１材料和方法１．１临床资料１５例壶腹癌，男９例，女６例。年龄３４～７３岁，平均５１．６岁，其中５０岁以上９例（占６０％）。临床主要症状：渐进性黄疸１５例（无痛性黄疸６例，上腹痛伴黄疸９例），上腹不适７例，乏力、纳差、体重减轻等。黄疸出现…     

Carcinoma of the ampulla of Vater: Sonographic and CT diagnosis

Twenty patients with carcinoma of the ampulla of Vater were studied with sonography (N = 9) or both sonography and CT (N = 11). The tumor was shown by sonography in 16 patients (80%) as a small, round or oval, fairly well delineated mass in between the dilated distal common bile duct and duodenum which was delineated owing to luminal fluid or gas (N = 13); or as a polypoid mass within the dilated distal common bile duct resulting in abrupt obstruction (N = 3). In the remaining four patients, the mass was not delineated. Bile ducts were dilated down to the level of mass or ampullary region in all cases (100%), while the pancreatic duct was dilated in five cases (45%). We believe that sonography is the technique of initial choice in the diagnosis of carcinoma of the ampulla of Vater by identifying the mass at the distal end of the dilated common bile duct and/or pancreatic duct.     

Rare histological subtype of invasive micropapillary carcinoma in the ampulla of Vater: A case report

BACKGROUNDCarcinoma of the ampulla of Vater is an uncommon ampullo-pancreatobiliary neoplasm, and the most common histological type is adenocarcinoma with a tubular growth pattern. Invasive micropapillary carcinoma (IMPC) is an aggressive variant of adenocarcinoma in several organs that is associated with lymph node metastasis and poor prognosis. IMPC was first described as a histological subtype of breast cancer; however, IMPC of the ampulla of Vater is extremely rare, with only three articles reported in the English literature.CASE SUMMARYWe have reported a case of IMPC of the ampulla of Vater in an 80-year-old man. Microscopically, the surface area of the carcinoma was composed of tubulopapillary structures mimicking intra-ampullary papillary-tubular neoplasm, and the deep invasive front area exhibited a pattern of IMPC. The carcinoma showed lymphatic invasion and extensive lymph node metastasis. The immunohistochemical study revealed mixed intestinal and gastric/pan-creatobiliary phenotypes.CONCLUSIONThis rare subtype tumor in the ampulla of Vater showed a histologically mixed phenotype and exhibited aggressive behavior.     

超声对壶腹癌诊断价值及检查方法的探讨

目的总结壶腹癌的声像图特征,探讨提高其显示率的方法。方法对我院超声诊断并经手术或CT证实的23例壶腹癌的声像图进行回顾性分析总结,扫查时对胆总管扩张者按常规追踪胆总管至壶腹部,显示不清者令患者一次饮水500ml以上,采取不同的体位,仔细观察胆总管下段、胰头及充盈的十二指肠壶腹,必要时令患者深呼吸、局部加压或咳嗽,动态观察病变部位及其与以上三者的关系。结果1.饮水后右侧卧位比平卧位、坐位图像清晰,配合深呼吸、咳嗽,动态观察有意义。2.壶腹癌声像图分以下四型团块型11例(48%);乳头型3例(13%);厚壁狭窄型5例(22%);末端堵塞型2例(9%);2例仅显示胆管全程扩张型,未见明显占位病灶。结论超声检查并辅以简便易行的辅助方法能较好地显示壶腹癌及其与周围结构的关系,是壶腹癌诊断重要的检查手段。     

B超对壶腹部肿瘤诊断价值初步探讨

目的：探讨Ｂ超对壶腹部肿瘤术前诊断价值。方法：回顾性分析３１例经病理和（或）手术证实的壶腹部癌。结果：术前Ｂ超检查诊断为壶腹癌２７例（８７．１％）,误诊胰头癌２例,误诊壶腹结石、总肝管结石各１例。本组定位诊断正确率９０．３％。壶腹部肿瘤声像图表现：１．直接征象：在壶腹部显示肿块回声;２．间接征象：肝内、外胆管扩张至胰头水平,胰腺正常或虽显示不清但在胰头区未探到肿块。结论：Ｂ超对壶腹部肿瘤诊断有很大的实用价值。     

Acute cholangitis detected ectopic ampulla of Vater in the antrum incidentally: A case report

BACKGROUNDThe ampulla of Vater is an opening at the confluence of the common bile duct and pancreatic duct. It is located in the second portion of the duodenum. An ectopic papilla of Vater is an anomalous termination. Few cases have been reported. We report the rare case of a man with an ectopic ampulla of Vater in the pylorus.CASE SUMMARYAn 82-year-old man had experienced abdominal pain and fever with chills 1 d before his presentation. A computed tomography scan of the abdomen demonstrated dilatation of the common bile duct approximately 2.2 cm in width. Gas retention was found in his intrahepatic ducts. Acute cholangitis with pneumobilia was identified, and he was hospitalized. Esophagogastroduo-denoscopy and endoscopic retrograde cholangiopancreatography disclosed no ampulla of Vater in the second portion of the duodenum. Moreover, a capsule-like foreign body (pharmaceutical desiccant) approximately 1 cm × 2 cm in size was found at the gastric antrum and peri-pyloric region. After the foreign body was removed, one orifice presented over the pyloric ring in the stomach, a suspected ectopic ampulla of Vater. Subsequently, sludge in the common bile duct was cleaned, and balloon dilatation was performed. The general condition improved daily. The patient was discharged in a stable condition and followed in our outpatient department.CONCLUSIONThis case involved an ampulla of Vater in an unusual location. Endoscopic retrograde cholangiopancreatography with balloon dilatation is the main treatment recommended and performed.     

超声造影对壶腹部周围癌诊断和鉴别诊断价值的初步研究

目的 探讨超声造影对壶腹部周围癌诊断和鉴别诊断的临床价值.方法 回顾分析22例壶腹部周围癌超声造影表现,全部病例均经手术病理证实,其中胆总管下段癌9例,壶腹癌5例,乳头癌3例,胰头癌5例.观测指标包括病灶大小及造影前后病灶的清晰显示率、增强开始时间和消退时间、增强水平及增强形态.结果 造影后病灶清晰显示率从造影前55%(12/22)提高到95%(21/22);病灶增强开始时间、消退时间和增强水平差异无统计学意义(P＞0.05),而增强形态和最大直径则明显不同:胰头癌多呈不均匀增强,管腔内均未显示突出物及"半月征",病灶直径显著大于胆总管下段癌、壶腹癌及乳头癌(P＜0.05),后三者病变多呈均匀增强,管腔内均显示突出物和(或)"半月征".结论 超声造影可显著提高壶腹部周围癌的清晰显示率,有助于病灶的定性诊断;病灶大小和增强形态对壶腹部周围癌的鉴别诊断具有重要的实用价值.     

肺大细胞神经内分泌癌的MSCT表现

目的探讨肺大细胞神经内分泌癌(LCNEC)的MSCT表现。方法回顾性分析27例经手术病理证实为LCNEC患者的MSCT影像与病理资料。所有患者术前均接受胸部CT平扫,其中20例接受增强扫描。结果 23例表现为肺内单发肿块,4例表现同侧肺内为多发结节;26例为周围型,仅1例为中央型;肿块或结节最大径为1.2～14.2cm[平均(5.2±2.1)cm]。主要CT征象:肿块或结节边缘光滑20例(20/27,74.07%),肿块内片状坏死9例(9/27,33.33%)、点状钙化2例(2/27,7.41%);分叶征19例(19/27,70.37%),毛刺征13例(13/27,48.15%),空泡征3例(3/27,11.11%),胸膜牵拉征7例(7/27,25.93%),伴肺内阻塞性病变4例(4/27,14.81%)。增强后20例病灶均呈不均匀强化。14例(14/27,51.85%)可见同侧肺门或纵隔、隆突下淋巴结肿大,其中8例病理证实为淋巴结转移。1例(1/27,3.70%)肿块累及胸壁,1例(1/27,3.70%)发生骨转移,1例(1/27,3.70%)发生脑转移,1例(1/27,3.70%)发生全身转移。结论 LCNEC影像学表现复杂,缺乏特征性,诊断需结合病理学。     

Radiology of papilla of Vater stenosis

The radiographic characteristics of the terminal pancreatic and biliary ducts were analyzed by endoscopic retrograde cholangiopancreatography in 25 patients with documented benign stenosis of the papilla of Vater. Demonstration of marked hypertrophy of the distal sphincter, mucosal hyperplasia or mucosal redundancy of the distal common bile duct, dilatation of the ducts, and prolonged retention of contrast media suggest papillary stenosis. The diagnosis of benign papillary stenosis, however, ultimately depends on physiologic measurements and response to therapy.     

多层螺旋CT诊断结节性甲状腺肿合并甲状腺癌

目的探讨多层螺旋CT对结节性甲状腺肿合并甲状腺癌的诊断价值。方法回顾性分析25例手术病理确诊为结节性甲状腺肿合并甲状腺癌患者CT资料,比较患者肿瘤数目、边界、形态、大小、密度等方面的情况。结果22例结节性甲状腺肿和甲状腺癌独立存在,3例为甲状腺癌病灶,位于结节性甲状腺肿内;其中,共发现结节性甲状腺肿病灶40个,甲状腺癌病灶28个。20例CT平扫癌灶呈明显低密度,边界相对清楚,增强后癌灶均匀或不均匀明显强化,边界不清楚,称为“边界反转征”;23例癌灶位于甲状腺边缘且18例突破包膜,出现“边缘中断征”;癌灶内钙化15例;颈部淋巴结转移13例。结论结节性甲状腺肿合并甲状腺癌的多层螺旋CT征象具有一定特征性,利用多层螺旋CT多平面重建技术全面观察每个结节,能有效减少结节性甲状腺肿中合并甲状腺癌的漏诊。