Palliative bile duct irradiation

Carcinoma of the common hepatic bile duct or common bile duct were treated by interstitial irradiation with gold seeds using the percutaneous transhepatic drainage partly boosted by external irradiation. The interstitial dose of 50 Gy was given in two applications and 40 Gy by linac. Twice histological examination showed wide tumor destruction of local irradiation, but also much more tumor extension than seen before by diagnostic investigation. Mostly the therapy is only palliative because of the infiltration of liver and lymph nodes.     

Percutaneous management of bile duct stones

This article presents a review of the interventional radiological procedures in the percutaneous management of the bile duct stones through T-tube or transhepatic tracts. Interventional stone removal techniques mainly include extraction through the T-tube tract with baskets or forceps and expulsion into the duodenum by means of baskets or balloon catheters with the dilatation of the sphincter of Oddi. Fragmentation or size reduction of the stone, dilatation of the strictures and cholangioscopic assistance can facilitate the procedures.     

超声引导下经皮经肝胆管穿刺术36例

近年来,非血管途径介入在胆道疾病诊断和非手术治疗方法中具有重要价值,常用的方法有ERCP介入术和经皮经肝穿刺胆道介入术;后者又可在x射线引导下或者超声引导下施行。2006年2月～2008年6月我院实施的经皮经肝穿刺胆道介入术逐步由x射线引导过渡为超声引导,操作相对简单、适用范围广泛、疗效确切肯定,效果满意。     

闽北地区肝胆管结石细菌感染耐药情况分析

目的探讨闽北地区肝胆管结石患者胆汁的细菌谱及细菌药物敏感性状况。方法对我院自2008年7月—2012年7月收治的330例肝胆管结石的患者进行胆汁细菌培养及药物敏感性试验,并对收集的资料进行统计学分析。结果 330例患者中198例培养阳性,阳性率为60%。共培养菌株207株,其中G-菌126株,占60.9%,G+菌81株,占39.1%。引起胆道感染较为常见的菌属依次为大肠埃希菌属、粪肠球菌属、肺炎克雷伯菌属、铜绿假单胞菌属。G-菌对头孢他啶、头孢哌酮钠-舒巴坦钠、亚胺培南、阿米卡星敏感性较高,G+菌对氨曲南、亚胺培南敏感性较高。结论随着闽北地区各种抗菌药的广泛应用,肝胆管感染细菌谱发生了一定变化,G+菌比例虽有所上升,但G-菌仍占较高比例,且细菌对抗菌药的耐药性有所上升,临床应根据培养结果合理应用抗菌药。     

Cholangiographic evaluation of bile duct carcinoma

Cholangiograms and clinical histories of 82 patients with biopsy-proved bile duct carcinoma were reviewed. The carcinomas were classified according to morphologic type and anatomic location, and these were correlated with surgical and pathologic findings and clinical outcome. Ulcerative colitis and antecedent inflammatory disease of the biliary tree, particularly primary sclerosing cholangitis, seem to predispose to the development of bile duct carcinoma. Focal stenotic lesions were the most common morphologic type (62/82). Polypoid carcinomas and diffuse sclerosing carcinomas were less common and of about equal frequency. Prognosis was best for patients with polypoid carcinomas and worst for those with diffuse sclerosing carcinomas. In 69 cases (84%), the tumors involved the intrahepatic or proximal extrahepatic ducts, making curative resection difficult or impossible. Patients with carcinomas limited to the more distal extrahepatic bile ducts had a longer average survival and a higher probability of surgical cure. Proper management of patients with bile duct carcinoma requires a complete and accurate cholangiographic evaluation of the morphology, location, and extent of the disease.     

选择性胆总管切开探查术后一期缝合胆总管34例体会

我院自1994-06～1998-12期间共进行胆总管切开探查术254例,其中34例不按常规放置T型管引流而行胆管壁的一期缝合,效果满意,现报告如下。1 临床资料1.1 一般资料 34例病人中,男性15例,女性19例,年龄26～68岁(平均46岁),其中胆总管结石26例,慢性结石性胆囊炎8例,均择期行手术治疗,8例结石性胆囊炎病人因术中见胆总管扩张明显,管壁增厚而行胆总管切开探查,34例病人均同时切除胆囊。术中取净结石后,探查胆总管内无残余结     

肝内外胆管及胆囊扩张程度和低位梗阻性黄疸病变的相关性

目的探讨肝内、外胆管及胆囊扩张程度、形式对低位梗阻性黄疸的诊断价值。方法回顾性分析105例低位阻塞性黄疸患者的CT和内窥镜逆行胰胆管造影（ERCP）的影像资料，将胆系扩张分为下列7种类型：Ⅰ型为肝内、外胆管及胆囊均重度扩张；Ⅱ型为肝外胆管、胆囊重度扩张伴肝内胆管轻度扩张；Ⅲ型为肝内、外胆管重度扩张伴胆囊不扩张或轻、中度扩张；Ⅳ型为肝外胆管重度扩张伴肝内胆管和胆囊不扩张或轻、中度扩张；Ⅴ型为肝内胆管重度扩张伴肝外胆管及胆囊不扩张或轻、中度扩张；Ⅵ型胆囊重度扩张伴肝内、外胆管不扩张或轻、中度扩张；Ⅶ型为肝内、外胆管及胆囊均不扩张或轻、中度扩张。结合手术和病理结果，分析各类型胆系扩展和其低位阻塞性黄疸病变的相关性。结果105例低位阻塞性黄疸中33例为肿瘤性病变，72例为非肿瘤性病变。肿瘤性病变中．Ⅰ型16例，Ⅱ型10例，Ⅲ型4例，Ⅳ型1例，Ⅶ型2例。非肿瘤性病变中，Ⅰ型4例，Ⅱ型4例，Ⅲ型9例，Ⅳ型33例，Ⅴ型2例，Ⅵ型11例，Ⅶ型9例。Ⅰ、Ⅱ型扩张和Ⅲ～Ⅶ型扩张在肿瘤和非肿瘤病变中差异有统计学意义（χ^2=47．33，P〈0．01）。结论低位阻塞性黄疸病变性质和肝内、外胆管及胆囊扩张程度密切相关：（1）Ⅰ型和Ⅱ型扩张提示绝大多数为肿瘤性病变，少数为嵌顿性结石。（2）Ⅲ～Ⅶ型扩张常为胆管、胆囊结石及炎症。     

肝内胆管脓肿的CT诊断

目的 :探讨肝内胆管脓肿的CT诊断和鉴别诊断。方法 :回顾性分析经临床、病理证实的 2 7例肝内胆管脓肿患者的CT表现及临床资料。结果 :2 7例均可见肝脓肿及胆源性病变表现。肝脓肿CT平扫表现为低密度肿块 ,单发圆形(8例 )、多房或簇状 (9例 )或不规则多发 (10例 ) ,增强扫描示脓肿实质部分明显强化 ,呈“肿块缩小征”6例 ,“周围充血征”8例 ,“簇状征”9例 ,“环靶征”仅 4例。胆源性病变CT表现包括胆管扩张、胆管壁增厚并明显强化 ,胆道积气及胆道结石等。结论 :CT扫描可发现肝脓肿及胆道病变 ,是临床诊断肝内胆管脓肿最可靠的影像学方法。     

Percutaneous treatment of benign bile duct strictures

PURPOSE: To evaluate long-term results of treatment of benign bile duct strictures. MATERIALS AND METHODS: From February 1994 to November 2005, 21 patients (9 men, 12 women) with median age of 50.6 years (range 27-77 years) were indicated to percutaneous treatment of benign bile duct stricture. Stricture of hepatic ducts junction resulting from thermic injury during laparoscopic cholecystectomy was indication for treatment in one patient, stricture of hepaticojejunostomy was indication for treatment in all other patients. Clinical symptoms (obstructive jaundice, anicteric cholestasis, cholangitis or biliary cirrhosis) have appeared from 3 months to 12 years after surgery. RESULTS: Initial internal/external biliary drainage was successful in 20 patients out of 21. These 20 patients after successful initial drainage were treated by balloon dilatation and long-term internal/external drainage. Sixteen patients were symptoms free during the follow-up. The relapse of clinical symptoms has appeared in four patients 9, 12, 14 and 24 months after treatment. One year primary clinical success rate of treatment for benign bile duct stricture was 94%. Additional two patients are symptoms free after redilatation (15 and 45 months). One patient is still in treatment, one patient died during secondary treatment period without interrelation with biliary intervention. The secondary clinical success rate is 100%. CONCLUSION: Benign bile duct strictures of hepatic ducts junction or biliary-enteric anastomosis are difficult to treat surgically and endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long-term internal/external drainage is feasible in the majority of these patients. It is minimally invasive, safe and effective.     

MRI for evaluating congenital bile duct abnormalities

Congenital bile duct diseases consist of ductal plate development abnormalities and are genetically determined. These biliary abnormalities are encountered mainly in congenital fibrocystic diseases, represented by congenital hepatic fibrosis and different forms of Caroli disease. On the other hand, polycystic hepatic diseases also present cystic abnormalities, which could be confused with biliary dilatations, especially in the perihilar area. Further, intricate forms between Caroli and polycystic hepatic diseases are possible. In congenital bile duct paucity, which is extremely rare, the biliary tree, located on the opposite, is not visible. MRI modalities for the analysis of the biliary tree are mainly represented by T -weighted sequence, also known as MR cholangiography (MRCP), and T gadolinium-enhanced sequences. Familiarity with the most common appearances of congenital bile duct dilations, its variants, and related complex diseases facilitates accurate diagnosis and allows and helps avoid misinterpretation.     

经内镜胆管引流术治疗胆道梗阻

目的：评价胆道梗阻的内镜治疗效果。方法：应用鼻胆管引流术9ENBD）及胆道内支架置入术（ERBD）进行胆道内、外引流。结果：58例病人内镜下胆管引流88例次，成功84次，成功率95．5％，ENBD 37例次，ERBD 51例次，引流后黄疽均有减退，恶性胆道梗阻者带瘤生存平均9．7月（3－18月），生活质量较高。结论：内镜下胆管引流是胆道梗阻的有效治疗方法，是急性梗阻性胆管炎、胆源性胰腺炎的有效治疗措施，可延长胆道恶性梗阻者带瘤生存时间并提高生活质量。