肝包虫囊肿破入胆道系统20例CT诊断

目的:分析肝包虫囊肿破入胆道系统的CT征象,讨论CT对该病的诊断.方法:回顾20例经手术证实的肝包虫囊肿破入胆道系统,结合CT征象进行分析并提出诊断.结果:20例肝包虫囊肿共有29个囊肿;其中单房单囊16个,单房多囊7个,多房多囊6个.囊肿壁见钙化10例;20例肝包虫囊肿均经肝内胆管破入胆道系统,致肝内胆管扩张者6例,肝总管、胆总管扩张14例;其中有2例合并主胰管扩张.结论:CT检查能很好地显示肝包虫囊肿破入胆道系统的影像学特征,提高诊断准确率,为手术提供可靠的影像学依据.     

肝细粒棘球蚴病的CT诊断

本文报道67例肝细粒棘球蚴病的CT表现,其中包括单房性包虫囊肿32例、多房性包虫囊肿35例。囊肿有钙化42例,并发破裂/感染34例。作者认为本病最主要的CT表现为肝内有边缘光滑、密度均匀的圆形或卵圆形阴影,CT值近于水。囊壁的显示及其钙化、子囊的存在,囊膜剥离征则具有特征性,可作为CT诊断本病的重要依据。作者探讨了本病CT表现的病理基础,并提出与肝囊肿、肝脓肿、坏死性或囊性肝转移瘤以及少见的肝内胆管癌和特殊的肝癌的鉴别。     

B超诊断肝包虫并发症的临床价值

目的：探讨肝包虫并发症的声像图特征。方法：对经手术证实具有并发症的68例79个肝包虫囊肿的声像图特征进行分析研究。结果：肝包虫合并感染62例，声像图特征为：囊壁增厚，囊内呈现点状、条状、片状不规则强回声。合并破裂10例，声像图特征为内外囊分离，囊液中可见迂曲强回声光带，若内外囊均破裂时，示包囊张力降低，部分包囊可见与胆管相通的瘘口，合并胆道梗阻4例，声像图特征为包囊外壁有缺口与胆管有交通形成，胆管内可见坏死包虫内容物呈层状排列，延伸到肝总管形成高位梗阻。结论：超声诊断肝包虫并发症具有较高的特异性，是诊断本病的首选检查方法。     

泡型肝包虫病肝内外转移的CT及MRI诊断

目的探讨肝泡型包虫合并肝内外转移的影像学特点及鉴别诊断。方法回顾性分析经手术病理证实的8例肝泡型包虫合并肝内外转移患者,分析其颅脑、胸、腹部CT及MRI特点。结果8例中,肝内、脑转移3例;脑、双肺转移3例;脑、肾转移1例;左后下纵隔转移1例。颅脑转移MRI表现为圆形、边缘光滑的多发囊性占位,与脑脊液信号相似,囊肿周围无水肿。囊周围钙化显示为低信号。肺转移CT表现为小囊肿周围有结节状或团块状钙化。肾转移CT表现为实质内可见类圆形低密度小囊,囊周有不规则沙粒样钙化。左下纵隔转移CT表现为囊性病变周围有结节状钙化。且以上8例实验室检查均为血嗜酸性粒细胞增多,囊液抗原皮内试验和补体结合试验阳性。结论CT及MRI是诊断肝泡型包虫及肝内外转移病变主要的辅助检查方法,其特征性钙化结合实验室检查可以为临床的早期诊断及鉴别诊断提供依据。     

37例肝包虫病的多层螺旋CT诊断分析

目的通过对肝包虫病的多层螺旋CT表现进行分析,提高肝包虫病诊断的准确率。方法回顾性分析本院经手术病理证实的37例肝包虫患者的CT表现,探讨多层螺旋CT在诊断肝包虫疾病中的价值。结果囊性包虫病16例,其中单纯囊肿9例,表现为圆形或类圆形低密度病灶,多发子囊型7例,表现为一个体积较大的母囊腔内多发沿母囊壁排列的小子囊,呈"车轮状"改变,钙化18例,表现为病变边缘的蛋壳样钙化、病灶内不规则点片状、条带状钙化、实质大部分钙化。泡状肝包虫3例,表现为大片不规则混杂密度病灶,呈"地图状"钙化。结论多层螺旋CT可显示肝包虫的大小、部位、形态及与周围组织的关系,提高诊断准确率,为手术提供可靠信息。     

肝包虫囊肿的CT诊断

为了提高对肝包虫囊肿的影像学诊断,本文采用CT诊断7例肝包虫囊肿,均经手术病理证实。CT结果表明:肝包虫囊肿有特异性CT表现即内囊破裂形成“地图”样内壁和子囊形成的“多环”,CT检查可为肝包虫囊肿病人的病变部位、累及范围提供准确的定位及定性诊断依据,说明CT检查对肝包虫囊肿的诊断有重要的临床价值.     

肝包虫的CT诊断与鉴别诊断

为探讨CT对肝包虫的诊断价值。对经手术证实的225例肝包虫的CT表现进行回顾性分析。结果，肝囊性包虫215例，其中单纯囊肿型110例，含子囊型98例。钙化40例，合并感染15例，并发破裂15例，肝泡型包虫10例，表现为境界不清的低密度肿块，常合并中心液化坏死，伴有不同程度的钙化，CT对肝包虫的分型及鉴别诊断都有较高的价值，是肝包虫术前检查的主要手段。     

肾包虫囊肿的CT诊断(附3例报告)

本文报告经手术证实的3例肾包虫囊肿的CT表现。其特征性表现是:(1)卵圆形或圆形水样密度囊肿。(2)母囊内有子囊。(3)囊膜剥离征象。(4)囊壁钙化。并讨论了本病的破裂感染和与先天性肾囊肿的鉴别诊断。     

钙化性肝包虫囊肿47例的外科治疗

肝包虫囊肿钙化后并发症率及手术治疗的死亡率明显高于非钙化性肝包虫囊肿 ,有关钙化性肝包虫病的治疗问题 ,有待进一步探讨。1　临床资料和方法我院从 1 960 1～ 2 0 0 0 1 2手术治疗肝包虫病973例 ,其中钙化性肝包虫囊肿 47例 ,占同期肝包虫手术的 4 83%。男 33例 ( 70 2     

肝包虫囊肿的磁共振诊断

对１０例经手术证实的肝包虫囊肿（又称细粒棘球蚴病）的磁共振成像（ＭＲＩ）进行分析，认为其特征性表现为：囊壁呈光滑厚薄均一的低信号的包膜，在Ｔ２加权像上显示更加清楚；母囊内有数个大小不等的子囊，整个病灶呈多房性似玫瑰花状。本文对肝包虫囊肿与肝内其它囊性占位病变的鉴别诊断进行了探讨。     

肝包虫术后残腔并发症的防治(附173例报告)

目的讨论肝包虫内囊摘除术后残腔并发症的防治方法。方法回顾分析我院1960年1月至2004年1月肝包虫内囊摘除术后外囊残腔并发症173例,占同期肝包虫手术的17．49％(173／989)。其中残腔感染104例(60．12％),残腔出血2例(1．16％),残腔胆汁漏51例(29．48％),钙化残腔不闭合13例(7．51％),残腔消化道瘘3例(1．73％)。87例(50．29％)经再次手术治疗。结果术后腹腔感染7例(8．05％),伤口感染11例(12．64％),肺部感染4例(4．6％),死亡3例(1．73％)。本组治愈率为98．27％。结论肝包虫内囊摘除术后残腔并发症发生率较高,其中以残腔感染及胆汁漏最为常见,部分病例治疗甚为困难,严重影响病人的生活质量甚至生命。包虫囊肿完整切除可有效地预防术后残腔并发症。近来有人提出包虫外囊与肝组织之间有一层疏松的结缔组织称为“外科膜”,该膜有利于包虫囊肿完整切除。作者认为包虫囊肿完整切除应根据病人的全身及局部情况和术者的经验而定,不可盲目从事。     

Clinical Experience in Treating Intracranial Hydatid Cysts: Report of 97 Cases

Background: Echinococcosis is still endemic in many countries, including China, especially in its north-west part, but the world literature which describes the Chinese experience in treating the cerebral hydatid cyst is still lacking. In this report, clinical manifestations, radiological features and surgical outcomes of 97 patients with intracranial hydatid cysts were analyzed and the transmission pattern, preoperative diagnosis, treatment methods and long-term outcome were discussed. Methods: We retrospectively reviewed the clinical features ( neurological symptoms and signs), radiological manifestations( X-ray, CT, MRI) and surgical outcome of 97 patients with intracranial hydatid cysts whom received surgical treatment at the neurosurgical department of Xinjiang Medical University between the year 1985 to 2010.We have followed up the patients via sending questionnaire or telephone contact. Clinical outcome was evaluated by using Karnofsky Performance Scale Index (KPSI). Results: Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases, which include hemiparesis, visual deficit, diplopia and aphasia. Epilepsy was occurred in five patients with hemispheric hydatid cysts. On X-Ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round shaped and thin walled homogeneous low-density cystic lesion without surrounding edema and enhancement were the main findings on CT in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts were manifested as a heterodensity lesions. On MRI, Hydatid cyst was manifested as a round low signal lesion in T1-Weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts were manifested as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulted in two surgery related mortality. There was no other additional neurological deficit caused directly by surgery. Patient outcome was 97.2% with Karnofsky Performance Scale score 80 to 90. Conclusion: Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas. CT and MRI have been proven to be the best diagnostic modality for diagnosing intracranial hydatid cyst. Surgery is the treatment of choice for intracranial hydatid cyst whenever possible.     

Treatment of intracranial hydatid cysts

Background  Echinococcosis is still endemic in many countries, including China, where it is especially prevalent in the northwest. The aim of this study was to enrich the international literature about the treatment of intracranial hydatid cysts.

Methods  We retrospectively reviewed the clinical features, radiological manifestations, and surgical outcome of 97 patients with intracranial hydatid cysts, who received surgical treatment at the Neurosurgical Department of First Affiliated Hospital of Xinjiang Medical University from 1985 to 2010 and followed up the patient via sending a questionnaire or telephone contact. Clinical outcome was evaluated using the Karnofsky Performance Scale Index.

Results  Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases. On the X-ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round-shaped and thin-walled homogeneous low-density cystic lesions without surrounding edema and enhancement were the main findings on computerized tomography (CT) in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts presented as a heterodensity lesions. On magnetic resonance imaging (MRI), hydatid cyst presented as a round-shaped low signal lesion in T1-weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts presented as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulting in two surgery-related mortalities. There was no other additional neurological deficit caused directly by surgery. In 97.2% of the patients, the Karnofsky Performance Scale score was 80 to 90 at the last follow-up.

Conclusions  Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas for echinococcosis. CT and MRI are the best diagnostic methods and surgery is the treatment of choice for intracranial hydatid cysts.

     

胃空肠吻合术后胆总管结石腹腔镜手术取石和内镜取石的比较

目的: 探讨胃空肠吻合术后胆总管结石腹腔镜手术取石或内镜取石的疗效及优劣。方法: 回顾性分析2012年1月至2016年12月的25例既往有胃空肠吻合手术史的胆总管结石患者的临床资料。按胆总管结石的处理方法分为腹腔镜手术组和内镜取石组,其中腹腔镜手术组15例,内镜取石组10例,比较两种方法的一般资料及治疗情况。结果: 25例胃切除术后胆总管结石患者,毕Ⅱ式(Billroth Ⅱ)吻合术21例,Roux-en-Y吻合术4例,其中6例患者在急性胆管炎状态下行手术或内镜取石。腹腔镜手术组15例患者中5例有大于1 cm的胆总管结石,7例有多发胆总管结石;内镜取石组10例患者中3例有大于1 cm的胆总管结石,4例有多发胆总管结石。腹腔镜手术组更多患者合并胆囊结石,其中6例经胆囊管取石成功,未放置T管,内镜取石组患者中4例内镜单次取石成功,其中3例为单发小结石,另1例为多发小结石。有2例患者因粘连严重腹腔镜手术失败中转开腹,1例Roux-en-Y吻合术患者内镜取石失败,转行腹腔镜手术取石。腹腔镜手术组和内镜取石组的中位住院时间分别为12 d和10 d。共有3例患者术后出现并发症,均经保守治疗后好转。结论: 腹腔镜手术及内镜取石在胃空肠吻合术后的胆总管结石治疗中均可行,各有优势,相互补充,两种方法均有较高难度,需结合具体技术能力合理选择。     

腹腔镜联合ERCP术治疗胆石症的护理体会

目的：探讨ERCP＋EST＋腹腔镜胆囊切除治疗胆囊结石合并胆总管结石患者的护理方法。方法：对本院2011年6月-2012年6月收治的经ERCP＋EST＋腹腔镜胆囊切除治疗胆囊结石合并胆总管结石患者的围手术期的心理护理、临床护理与监测、健康教育进行回顾性分析。结果：89例例胆囊结石合并胆总管结石患者手术成功,恢复良好。结论：对于胆囊结石合并胆总管结石患者先进行ERCP＋EST术,在先将胆总管内的结石取出后再进行腹腔镜胆囊切除手术,使得患者避免了传统手术导致的切口疼痛,多管引流导致的活动限制、术后禁食时间长,带T管时间长、易发生胆道感染的缺点,并且使住院天数减少,患者舒适度增加、痛苦小、恢复快等优点而成为胆道系统结石治疗的首选方法。     

胆囊切除术中预防胆总管结石漏诊的对策

目的 探讨胆囊切除术中预防胆总管结石漏诊的方法。方法 总结性分析我院1147例胆囊切除术中发现术前漏诊的胆总管结石18例临床资料。结果 通过术中仔细触摸胆总管发现结石9例，胆道造影发现结石4例。胆道镜检查发现结石5例。结论术中对胆总管的仔细触摸，胆道造影及经扩张胆囊管行胆道镜检查是预防胆囊切除术中胆总管结石漏诊的重要方法。     

胆道镜在胆道探查中的应用体会

目的探讨胆总管探查术中、术后胆道镜探查取石治疗经验体会.方法回顾性分析我院2007年12月至2009年8月经治132例行胆总管探查术中经胆道镜取石及术后经T管窦道胆道镜检查、取石治疗的临床病例资料.结果132例患者,术中取石12例,95%可信区间为4.21%～13.97%,成功8例;术后胆道镜检查发现残余结石41例,95%可信区间为23.28%～38.84%,成功取石39例.术后黄疸加重3例,经保肝支持治疗治愈;3例术中胆道出血,局部处理血止;均无窦道损伤穿孔,无胆管炎及胰腺炎发生.结论术中术后的胆道残石处理仍是胆道外科难题,而纤维胆道镜在治疗胆道结石中的作用无可替代,但胆道镜取石可出现多种并发症,只要处理及时、方法妥当,均可避免产生严重后果.     

ERCP途径治疗高龄患者胆总管巨大结石的临床护理研究

目的探讨经内镜(ERCP途径)治疗高龄患者胆总管巨大结石的可行性和护理操作配合。方法 40例高龄胆总管巨大结石患者完善术前准备,在密切监护下经十二指肠镜先行内镜下逆行胰胆管造影术(ERCP),发现胆总管结石后行内镜下十二指肠乳头括约肌切开术(EST)和机械碎石术(EML)取石,视具体情况留置鼻胆管引流。结果 38例取石成功,取石成功率95.0%,有11例行鼻胆管引流。乳头肌切口创面轻度渗血4例,一过性高淀粉酶血症9例,未发生严重并发症和死亡。结论 ERCP途径(EST联合EML)治疗高龄患者胆总管巨大结石安全有效,娴熟的内镜操作技术、专科护士精心的术前准备、准确迅速的术中配合和监护,以及完善的术后护理是保证治疗成功的重要条件。     

EST联合LC治疗胆囊结石合并肝外胆管结石

目的探讨腹腔镜胆囊切除术（1aparoscopic cholecystectomy,LC）和内镜下Oddi括约肌切开取石术（endoscopic sphincterotomy,EST）在治疗胆囊结石合并肝外胆管结石中的临床应用价值。方法对62例胆囊结石合并肝外胆管结石的患者先行EST,然后行LC。结果2例因EST取石失败而改开腹手术,其余60例获得成功,无肠穿孔、胆漏等严重并发症发生。8例出现一过性血淀粉酶升高,4例出现肠道出血,均经保守治疗后治愈。结论EST联合LC治疗胆囊结石合并肝外胆管结石是一种安全有效的治疗模式。