成人肝外胆管囊肿临床分析

目的：探讨成人肝外胆管囊肿的诊断及治疗方法。方法：回顾性总结分析1987-1998年我院收治的成人肝外胆管囊肿51例，结果：发现成人肝外胆管囊肿临床表现具有典型胆管囊肿三联征者少，仅19.6%；合并病变发生率高，达45例，包括胆管炎6例、胆结石21例、胆汁性肝硬变8例、胆道癌变8例、急性胰腺炎2例，是病性加重的主要原因；胆管囊肿切除、肝总管空肠Roux-Y吻合术后并发症较少、效果良好。结论：认为早期诊断、早日手术、彻底切除囊肿，是减少合并病变发生、提高治愈率的关键。     

成人先天性胆管囊状扩张症的诊治体会

目的探讨成人先天性胆管囊状扩张症的诊断及治疗方法。方法回顾性分析我院1986-2008年收治的成人先天性胆管囊状扩张症46例的I临床资料。结果46例中具有典型临床表现（腹痛、黄疸、腹部包块）者仅11例。45例检查辅以BUS、CT、ERCP、MRCP获确诊,误诊为“胰腺假性囊肿”1例,确诊率为97．8％。其中35例行囊肿切除,肝胆空肠ROUX—EN—Y形吻合胆道重建术。40例手术后早期恢复,无手术死亡病例。结论成人先天性胆管囊状扩张症仅靠临床表现不易确诊,应辅以影像学检查能明确诊断,手术以采用“囊肿切除肝管空肠ROUX—EN—Y形吻合胆道重建术为根治性术式。     

超声诊断先天性胆管囊肿及其癌变的价值

目的 探讨超声诊断先天性胆管囊肿及其癌变的临床价值。方法 先天性胆管囊肿22例，男10例，女12例。超声检查观察囊肿的部位、大小、形态、合并炎症、结石与癌变等情况，并与手术病理检查结果进行对比研究。结果 超声检查诊断为先天性胆管囊肿22例，其中肝外型胆管囊肿54．5％(12／22)、混合型胆管囊肿45．5％(10／22)。其中单纯囊肿22．7％(5／22)，囊肿合并炎症77．3％(17／22)，合并结石54．5％(12／22)，癌变22．7％(5／22)。与手术病理对照，结果 除1例超声诊断为先天性胆总管囊肿而手术证实为肝总管囊肿，其部位略有差异外，其余全部符合。结论 超声检查不仅是诊断先天性胆管囊肿的可靠方法，而且对明确囊肿有无合并炎症、结石，特别是癌变，有重要的临床实用价值。     

先天性胆管扩张症9例诊治体会

我院1995～1999年收治先天性胆管扩张症患儿9例,现就其诊治体会总结如下。1临床资料1．1一般资料男2例,女7例;年龄2．5～13．0岁。均符合先天性胆管扩张症诊断标准[1],并经手术证实。1．2病理分型胆总管囊性扩张型8例（88．8％）,肝内、外胆管多发性囊肿1例（11．2％）。1．3方法与结果囊肿切除、胆囊切除＋胆总管囊肿切除、胆囊切除＋肝总管空肠Roux－Y吻合7例（77.7％）,囊肿空肠内引流术1例（11．1％）,肝外胆管囊肿切除、肝总管空肠Roux－Y吻合于肝叶切除术1例（11．1％）。均治愈,未发现后遗症。2讨论2．1诊断典型的先天性胆…     

先天性胆管囊肿再次手术原因分析

目的：探讨先天性胆管囊肿再次手术的原因和外科处理方法。方法：回顾性分析我院1987年-2002年收治的先天性胆管囊肿139例中40例再次手术患者的临床资料。结果：再次手术以囊肿切除、肝管空肠Roux—m—Y吻合为基本术式，平均随访3．8年，效果满意。结论：先天性胆管囊肿治疗不及时和手术处理不当是导致再次手术的主要原因，囊肿切除和通畅引流是再次手术的基本原则。     

先天性胆管囊肿48例再手术原因探讨及对策

目的：探讨先天性胆管囊肿再手术的原因、预防及手术治疗对策。方法：回顾性分析48例先天性胆管囊肿再次手术患者的临床资料。结果：再手术48例中，40例成功行囊肿切除、胆道重建术，术后生活质量优良(37／40)，对已切除囊肿者以解决胆肠吻合口狭窄为重点。结论：胆管囊肿首次术式选择和手术处理不当出现多种并发症是导致再手术的原因，囊肿切除、肝总管空肠Roux-en—Y吻合术是再次手术的首选术式。     

先天性胆总管囊肿的超声诊断

目的：探讨超声对先天性胆总管囊肿的诊断价值。方法：分析21例先天性胆总管囊肿．采用超声观察囊肿的部位、大小、形态、结石与癌变情况。所有病例均经手术和病理证实。结果：肝外型胆总管囊肿18例，混合型胆管囊肿3例．合并胆总管结石5例，癌变3例。超声诊断符合率为95．2％(20／21)，结论：超声检查不仅是诊断先天性胆总管囊肿的可靠方法．而且对明确囊肿有无结石、特别是有无癌变，以及确定手术治疗。方案具有重要实用价值。     

肝内胆管结石的外科治疗

目的：探讨治疗肝内胆管结石的方法及临床疗效。方法：回顾性分析我院1520例肝内胆管结石病人行外科治疗的资料，对比不同治疗方法的临床效果，总结各种方法在临床治疗中的作用和适应证。结果：(1)手术组，单纯胆囊切除 胆总管切开“T”管引流489例，左肝叶切除86例，右肝叶切除25例，胆肠吻合术31例；(2)胆道镜组，胆囊切除 胆总管切开“T”管引流789例，左肝叶切除63例，右肝叶切除21例，胆肠吻合术16例。术后结石取净率，残石率，5例，10年复发率分别为：手术组71％，29％，45．8％，66．7％；胆道镜组98．8％，1．2％，2．9％，7．2％。术后并发症情况：手术组27．6％，胆道镜组5．6％。结论：手术配合胆道镜是治疗肝内胆管结石的有效方法。     

HASTE法磁共振胰胆管造影诊断胆道病变的应用价值

目的：探讨HASTE法单次屏气磁共振胰胆管造影（HASTE－MRCP）诊断胆道病变的应用价值。方法：对照分析75例胆道病变患者的HASTE－MRCP影像和手术结果，并与经皮肝穿刺胆管造影（PTC）比较。结果：HASTE－MRCP诊断胆道病变，正确率96％（72／75）；诊断胆管恶性梗阻灵敏度97．1％，特异率95％，阳性预测值94．4％，阴性预测值97．4％。35例恶性胆管梗阻中，HASTE－MRCP显示癌肿32例，其癌肿发现率高于PTC（8／35）。结论：HASTE－MRCP在胆道病变诊断中具有准确的定性诊断价值。     

肝内胆管结石合并肝内胆管癌56例临床分析

目的探讨肝内胆管结石合并肝内胆管癌的临床特点、诊断和治疗方法。方法分析56例经手术病理证实的肝内胆管结石合并胆管癌的临床资料。结果56例患者中，肝内胆管结石合并肝内胆管癌在所有肝内胆管结石的病例中占6．07％（56／923）。CA199全组检测阳性率达85．71％；术前B超、CT和MRI／MRCP对肝内胆管结石并发肝内占位病变确诊率分别为53．57％、61．710％、69、77％。手术根治切除率、姑息切除率分别为46．43％、25．00％。根治切除组l、2、3年生存率分别为92．28％、69，23％、53．84％；姑息切除组1、2、3年生存率分别为35．73％、21，41％、0．00％；无法切除组1年生存率为0．00％。结论肝内胆管结石症状反复发作、血CA199阳性、合并有肝内胆管结石病史的肝脏占住对于诊断肝内胆管癌有重要价值。积极的手术切除能提高生存率。     

Intraoperative fluorescent cholangiography using indocyanine green for laparoscopic fenestration of nonparasitic huge liver cysts

Bile duct injury is one of the known serious complications of laparoscopic fenestration for nonparasitic liver cysts. Herein, we report the case of a huge liver cyst for which we performed laparoscopic fenestration using intraoperative fluorescent cholangiography with indocyanine green. A 71‐year‐old woman with abdominal distention was referred to our hospital. CT demonstrated a 17 × 11.5‐cm simple cyst replacing the right lobe of the liver, so laparoscopic fenestration was performed. Although the biliary duct could not be detected because of compression by the huge cyst, fluorescent cholangiography with indocyanine green through endoscopic naso‐biliary drainage tube clearly delineated the intrahepatic bile duct in the remaining cystic wall. The patient had no complications at 3 months after surgery. Fluorescent cholangiography using indocyanine green is a safe and effective procedure to avoid bile duct injury during laparoscopic fenestration, especially in patients with a huge liver cyst.     

MRI及MRCP在先天性胆管囊肿及合并症中的诊断价值

目的探讨磁共振成像（MRI）及磁共振胆胰管成像（MPCP）对先天性胆管囊肿及其合并症的诊断价值。方法回顾性分析29例经病理证实的先天性胆管囊肿患者的MRI及MRCP影像表现。结果29例先天性胆管囊肿,10例Ib型,7例Ic型表现为仅限于胆总管局限性扩张,MRCP示扩张胆总管与胆管树相通。10例IV型,2例V型表现为肝外和／或肝内及仅限于肝内多发胆管扩张,MRCP示胆管树呈多发大小不等囊柱状。合并结石7例,Ib型4例,IV型3例,表现为胆管内单发和／或多发边界清楚无强化灶。合并肿瘤3例,IV型及V型合并胆管癌各1例,表现为扩张胆管壁内强化结节;1例Ib型合并胆囊癌伴肝内多发转移。1例V型合并闭锁表现为扩张胆总管远端中断。1例VI型合并胰腺炎。MRI及MRCP能准确地做出胆管囊肿的诊断并能进行准确的分型,定位,定位准确率达100％,并能清楚显示胆管囊肿的合并症。结论MRI及MRCP检查在先天性胆管囊肿的诊断及显示其合并症中具有重要的价值。     

成人型胆管囊肿的诊治分析

目的：探计成人型胆管囊肿的临床特点和治疗方法。方法：收集1994年12月-2004年12月上海复旦大学附属华山医院普外科收治的成人胆管囊肿15例，所有病例均经B超、胆道造影检查确诊并按Todani’s分型，随后行囊肿切除＋胆管空肠Roux-en-Y吻合（1例因急性胆道出血而未行该术式）。结果：所有手术患者无一例死亡，病理证实为胆管囊肿13例，1例为胆管囊腺瘤，1例未取病理。随访期8年，无复发、残余囊肿无癌变。结论：ERCP、MRCP对于成人型胆管囊肿的诊断，尤其是临床分型具有重要的作用，而ERCP更能为某些有严重并发症的患者创造手术条件。囊肿切除＋胆管空肠Roux-en-Y吻合仍为标准术式。     

Spectrum of biliary disease in childhood

Obstructive biliary disease in childhood is not common, but should be considered in the differential diagnosis of a child with jaundice, abdominal pain, or an abdominal mass. We have reviewed the experience at Vanderbilt Children's Hospital from 1970 to 1985, during which 87 children 18 years of age or younger with biliary tract disease were seen. Twelve patients (14%) had congenital disorders including choledochal stenosis, Caroli's disease, choledochal cyst, teratoma of the common hepatic duct and common bile duct, congenital septate biliary tree, and isolated atresia of the distal common bile duct. Thirty patients had neonatal cholestatic syndromes, and 37 had calculous disease of the gallbladder or extrahepatic bile ducts. Three patients had obstruction of the common bile duct caused by fibrosing pancreatitis. Two had sclerosing cholangitis. Obstruction of the common bile duct was caused by metastatic neoplasm in three patients. We discuss principles of diagnosis and management.     

Endoscopic management of liver abscesses and cysts that communicate with intrahepatic bile ducts

BACKGROUND AND STUDY AIMS: The formation of a communication between liver abscesses or cysts and intrahepatic bile ducts is an uncommon cause of significant bile leak. Surgical management of biliary fistulas is associated with high morbidity and mortality. We performed a prospective study of endoscopic management of this type of biliary fistula. PATIENTS AND METHODS: We studied 26 patients who had either liver abscesses or hepatic cysts that had ruptured into the intrahepatic bile ducts. The presence of a biliary fistula was suspected by jaundice and/or by the appearance of bile in percutaneous drainage effluent from a liver abscess and was confirmed by endoscopic retrograde cholangiopancreatography. Once the route of the fistula between the liver abscess or cyst and the intrahepatic bile duct had been defined by cholangiography, patients underwent treatment by sphincterotomy, and either biliary stenting or nasobiliary drainage. Nasobiliary drains or biliary stents (both 7 Fr) were placed according to standard techniques. Nasobiliary drains were removed when bile leakage stopped and closure of the fistula was confirmed by cholangiography; stents were removed after an interval of 4-6 weeks. RESULTS: Of a total of 525 patients with hepatic abscesses or cysts who were seen over a 5-year period, there were 26 patients who developed a demonstrable communication between liver abscesses (n = 20; 16 amebic, four pyogenic) or hydatid cysts (n = 6) and intrahepatic bile ducts (right intrahepatic bile ducts in 22 patients, left intrahepatic bile ducts in four patients). We performed either sphincterotomy with insertion of a nasobiliary drain (n = 20) or sphincterotomy with biliary stenting (n = 6). The fistulas healed in all patients after a mean time of 4 days (range 2-20 days) after endoscopic treatment. We were able to remove the nasobiliary drainage catheters and stents 6-34 days after their placement. CONCLUSIONS: In this case series, endoscopic therapy appears to be an effective mode of treatment for biliary fistulas complicating liver abscesses and cysts.     

儿童先天性胆总管囊肿17例诊治体会

目的探讨儿童先天性胆总管囊肿的诊断及外科治疗。方法对17例儿童先天性胆总管囊肿患儿的临床资料进行回顾分析。结果17例患儿中16例行胆总管囊肿切除＋肝总管空肠Roux—en—Y吻合术,1例行囊肿外引流术。术后出现胆漏2例,经保守治疗治愈。所有患儿均随访2—12个月,未出现胆道感染、胰腺炎及肝功能异常。结论B超检查简单方便、无创伤,对儿童先天性胆总管囊肿诊断的准确率高,可作为首选诊断方法。儿童先天性胆总管囊肿应尽早手术．手术方式首选胆总管囊肿切除及肝总管空肠Roux—en—Y吻合术。     

小儿先天性胆管囊肿的CT诊断（附21例报告）

目的 探讨小儿先天性胆管囊肿的CT诊断及鉴别诊断。方法 对21例经手术和/或病理证实的资料完整的小儿胆管囊肿病例进行回顾性分析。结果 21例先天性胆管囊肿的CT表现如下：（1）单纯胆总管囊性扩张13例,表现为肝门区或胰头区附近圆形的水样密度灶,增强囊内无变化。（2）肝内胆管多发囊性扩张2例,表现为肝内多个囊并且太,梭状低密度灶,增强后,可见其内有中心点状及树枝状明显强化灶。（3）肝内外胆管多发囊性扩张6例,同时具有以上两种征象,本病需与胰头囊肿,右肾囊肿,肠系膜囊肿,肝内单发或多发囊肿,梗阻性肝内胆管扩张等病鉴别。结论 CT是诊断小儿先天性胆管囊肿的重要方法。     

胆管囊肿的CT诊断

目的：探讨胆管囊肿的临床、病因、分型及ＣＴ诊断与鉴别诊断问题。材料与方法：对１３例患者的临床资料与ＣＴ资料进行了回顾性分析。结果：１０例胆总管呈圆形或椭圆形扩张，１例肝内胆管呈多发性局限性囊状扩张，２例同时累及肝内、外胆管，２例胆系造影ＣＴ扫描，造影剂进入囊肿内。结论：ＣＴ扫描对本病的诊断具有很大的价值。     

Effectiveness of endoscopic treatment modalities in complicated hepatic hydatid disease after surgical intervention

BACKGROUND AND STUDY AIMS: Hepatic hydatid cyst is a common disease in Turkey and the rupture of the cyst into the biliary tract is the most common complication which is difficult to detect and to manage. The aim of this study was to investigate the effectiveness of endoscopic treatment modalities in hydatid cyst patients with biliary complications who had previously undergone surgery. PATIENTS AND METHODS: Over the last 8 years, by means of endoscopic retrograde cholangiopancreatography (ERCP), we have examined 87 patients with postoperative biliary symptoms who had previously undergone surgery for hepatic hydatid disease of the liver. Endoscopic treatment modalities were as follows: endoscopic sphincterotomy (ES) and nasobiliary drainage in patients with biliary fistula; balloon and or bougie dilation and stenting in patients with biliary stricture; and ES and balloon extraction in patients with residual hydatid material within the bile duct. RESULTS: Findings from ERCP included biliary fistula in 55 patients (63.2 %), biliary stricture in 16 (18.4 %), and residual hydatid material within the bile duct in 14 (16.1 %). Two patients had normal findings on ERCP. In total, 85 patients were treated by means of endoscopic modalities. The time to closure of fistula was 17.8 +/- 5 days and the rate of fistula closure was 81 %. Biliary stenting was performed in 13 patients with biliary stricture. Endoscopic removal of hydatid material was achieved in 14 patients. The overall success rate of endoscopic treatment was 86 %, and a second surgical intervention was required only in six patients. No serious complication was encountered after endoscopic procedures. CONCLUSIONS: Endoscopic treatment modalities are safe and helpful methods for the treatment of biliary complications of hepatic hydatid cyst in the postoperative period.