两有助诊断胆道阻塞性疾病的X线征象

本文观察了112例静脉滴注胆系造影的病例，除发现肝管先于胆总管显影对判断胆道阻塞确有价值外，尚发现肝管第三级分支显影也是判断胆道阻塞的一个重要依据，现报告如下。     

应用螺旋CT胆道造影诊断胆管阻塞的可靠性研究

目的　研究螺旋CT胆管造影 (SCTC)诊断胆管阻塞可靠性及应用价值。方法　回顾分析经手术病理及ERC证实的 65例胆系疾病患者SCTC结果 ,以手术病理或 /和ERC为金标准 ,据临床流行病学诊断试验研究方法 ,分析SCTC诊断胆系阻塞的可靠性及应用价值。结果　胆管显影率 89% ,诊断胆管阻塞部位及原因准确率 89% ,肝外主胆管阻塞部位、原因准确率 97% ,灵敏度92 % ,特异度 95 % ,观察者间观察符合率 93 % ,卡帕值 0 .71。结论　SCTC 3D图像结合轴位像能准确显示阻塞部位和原因 ,为胆管复合结石的术前诊断及胆系术后随访提供了新的检查方法     

影响术中胆道造影的因素及防范

术中胆道造影是胆道手术中了解有无结石残留的手段之一，造影的成功是临床治疗胆管结石的重要保证。本文对近几年55例术中胆道造影进行分析，并探讨了影响术中胆道造影的因素及防范方法。     

肺癌阻塞性肺炎“癌头尾”征象的CT鉴别诊断

肺癌阻塞性肺炎早期临床和影像表现与一般肺炎极相似,是早期中央型肺癌常见的表现之一,但常被误诊,应提高警惕[1].笔者收集经手术病理证实、CT检查资料完整的31例肺癌病例和18例良性感染性病变做回顾性分析,并就有关问题进行讨论,以便提高对本病的CT诊断水平.     

介入治疗在输卵管阻塞复通术中的应用

输卵管阻塞是造成女性不孕症的最主要原因，据报道占２／３以上犤１犦。传统的治疗方法常选用通气、通液或剖腹手术等，但疗效欠佳。１９８８年Turmon与Rosch首次报道介入治疗输卵管阻塞复通术取得较佳效果犤２犦。介入治疗输卵管复通术是X线诊断与临床治疗相结合的非手术技术，其安全高效且并发症少。我院从２００１年～２００２年３月应用此技术为１８例患者治疗。１材料与方法１．１材料年龄２２～３０岁的不孕妇１８例，不孕时间２～６a。原发性不孕８例，继发性不孕１０例。以上患者均经妇产科及影像检查，生殖系统发育正常，证实为…     

胆道术后胆总管下段梗阻—59例经T形管胆道造影所见及其病因探讨

本文报告59例胆道手术后胆总管下段梗阻经T 形管造影所见,并探讨其病因。发现胆总管下段结石梗阻分别为凹面和凸面内多数充盈缺损表现。单纯Oddi 氏括约肌炎性狭窄表现为凸面形,常在远端见到高密度线状影;整个下段狭窄表现为削尖形。Oddi 氏括约肌痉挛缺乏特征性,对此诊断需多加分析,必要时作动态观察或复查,以作出正确的判断。     

螺旋CT胆系造影诊断胆管阻塞

目的用螺旋ＣＴ胆系造影（ＳＣＴＣ）显示胆管狭窄部位和程度，以及扩张胆管的范围。方法阻塞性黄疸患者３７例。用３０％胆影葡胺４０～６０ｍｌ静脉缓注，延迟２５分钟后行螺旋ＣＴ扫描并作三维成像。结果胆管显影率为８１％，３０例显影患者均能显示阻塞部位及扩张胆管，定性诊断正确率为９３％。结论ＳＣＴＣ能显示胆管狭窄部位、程度及胆管扩张范围，安全、简单、可靠。能观察肝分泌功能，估价胆汁流通畅程度，是显示胆系阻塞的有效方法     

肝胆管新型隐球菌感染并胆道阻塞一例报告

石××,男性,8岁.住院号154141.因右上腹阵发性疼痛半年,伴黄疸半个月于1984年3月20日入院.患儿于1983年10月无何诱因出现右上腹隐痛,无发热及恶心呕吐,食欲稍差,大小便正常,按胃病治疗无效。1984年2月中旬皮肤、巩膜发黄,厌油,大便时呈白色,当地医院     

Common bile duct obstruction: assessment by transcholecystic cholangiography

Percutaneous transcholecystic cholangiography was performed in 20 patients. Fifteen patients had normal-sized bile ducts on sonograms and computed tomographic scans, and five had partial common bile duct obstruction. Gallbladder pressures were measured in 14 patients. In all cases the intrahepatic and extrahepatic bile ducts were well visualized. Only one clinically significant complication, bile peritonitis, occurred, and it was relieved by inserting a cholecystostomy catheter. Techniques as well as the potential indications for transcholecystic cholangiography are discussed. The authors believe the transcholecystic approach is a useful alternative to transhepatic cholangiography.     

Intravenous cholangiography in different degrees of common bile duct obstruction. An experimental study in the dog.

A total of 83 cholangiograms was performed in three cholecystectomized dogs equipped with Thomas cannulas through which complete and different degrees of incomplete common bile duct obstruction were produced. With incomplete common bile duct obstruction, the iodine concentration in the bile necessary for radiographic visualization of the common duct was always obtained for all three tested iodipamide dosages of .3, .6, and 1.2 ml/kg, infused over 30 minutes. The largest dose resulted in the highest biliary iodine concentrations. With increasing obstruction, an increasing delay of the biliary iodipamide excretion was noted. With complete common bile duct obstruction the iodine concentration in the bile necessary for radiographic visualization of the common duct was never obtained, even with an iodipamide dose increased to 1.8 ml/kg and/or prolongation of the contrast material infusion time from 30 minutes to 2 and 6 hours. Nevertheless, the highest biliary iodine concentration in complete common bile duct obstruction resulted with the largest iodipamide dose (1.8 ml/kg) and the shortest infusion time (30 minutes).     

磁共振胆道造影在胆道梗阻定位和定性诊断中的价值

目的：通过ＭＲＩ胆道造影（ＭＲｃｈｏｌａｎｇｉｏｇｒａｐｈｙ，ＭＲＣ）与ＣＴ、ＵＳ、经皮穿刺胆道造影术（ＰＴＣ）或内窥镜逆行胰胆管造影术（ＥＲＣＰ）及手术、病理的对照研究，评价ＭＲＣ显示胆道梗阻部位，确定梗阻原因的能力。材料与方法：３０例梗阻性黄疸的患者在ＧＥＳｉｇｎａ１．５Ｔ超导系统上进行了ＭＲＣ检查，并与ＰＴＣ或ＥＲＣＰ、ＣＴ、ＵＳ、手术及病理对照。结果：本组资料中，ＭＲＣ显示胆道梗阻的部位准确性达１００％，优于有损伤性的ＰＴＣ或ＥＲＣＰ。ＭＲＣ确定梗阻原因的准确性达７０％，类似于ＰＴＣ或ＥＲＣＰ、ＣＴ、ＵＳ。结论：初步研究结果表明，无损伤性的ＭＲ胆道造影在梗阻性黄疸的定位和定性上具有很高的敏感性、准确性，对于梗阻性黄疸，特别是行ＥＲＣＰ失败和不宜行ＰＴＣ或ＥＲＣＰ的病人是最有效的替代方法。     

The "liver scan" appearance in cholescintigraphy. A sign of complete common bile duct obstruction

One hundred consecutive Tc-99m IDA hepatobiliary scans were reviewed revealing 14 scans (14%), that showed nonvisualization of the common bile duct (CBD), gallbladder (GB), and small bowel (SB), but good hepatic uptake of Tc-99m IDA derivative, a pattern designated by us as "the liver scan appearance." In 11 of 14 cases (79%), the diagnosis of complete CBD obstruction was confirmed by surgery, percutaneous transhepatic cholangiogram (PTC), endoscopic retrograde cholangiopancreatography (ERCP), and/or percutaneous needle biopsy (PBx). Common bile duct obstruction was suspected but not proven in the other three cases. The cholescintigraphic, ultrasound, PTC, ERCP, intraoperative cholangiogram, clinical, laboratory, and surgical findings are presented and correlated. The "liver scan-appearance" by cholescintigraphy should suggest a diagnosis of complete common bile duct obstruction; however, it does not specifically differentiate between stone or tumor as the cause of obstruction.     

Ultrasonic cholangiography. Gray-scale B-scan evaluation of the common bile duct.

Gray-scale B-scanning permits evaluation of major portions of the bile ducts, especially those with significant dilatation. Injection of contrast material containing microscopic air bubbles through a T-tube with simultaneous ultrasonography detected multiple echoes filling in the previously echo-free area which represented the common bile duct, outlining both the duct and portions of the major tributaries. Reflections could be obtained from stones within the duct. Follow-up examinations after surgery could be used to demonstrate shrinkage of the duct. Jaundice due to extra- or intrahepatic obstruction was successfully differentiated noninvasively.     

Percutaneous transhepatic cholangiography with selective catheterization of the common bile duct.

Percutaneous transhepatic cholangiography was performed in 86 patients with juandice in whom the diagnosis could not be established by conventional means. Selective catheterization of the common bile duct was employed and cholangiograms of high quality were obtained. In cases of obstruction of the biliary passages, the catheter was left indwelling centrally in the biliary passages for external bile drainage. Thus immediate postcholangiogram surgery was not required in these patients. The procedure was successful in all 60 patients with obstructive jaundice. In 26 patients the possibility of obstruction was ruled out. Complications occurred in four patients but were not exclusively due to the procedure. The incidence of complications may be maintained at an acceptably low level if the technique is meticulously followed.     

Positive predictive value of cholescintigraphy in common bile duct obstruction

Technetium-99m DISIDA imaging was employed in 400 patients to differentiate obstruction of the common bile duct from medical and other surgical causes of hyperbilirubinemia. Sequential anterior images demonstrated variable degrees of liver uptake, yet there was no evidence of intrabiliary or extrabiliary radioactivity for at least 4 hr after injection in 25 patients. Twenty-three patients were surgically documented to have complete obstruction of the common bile duct. One patient had hepatitis, and another had sickle cell crisis without bile duct obstruction. The remaining patients had either partial or no obstruction of the common bile duct. We conclude that the presence of liver uptake without evident biliary excretion by 4 hr on cholescintigraphy is highly sensitive and predictive of total obstruction of the common bile duct.