胆囊、十二指肠瘘的超声图表现

目的：探讨胆囊、十二指肠瘘超声图表现的病理基础。材料和方法：回顾分析７例经病理证实的胆囊、十二指肠瘘术前超声表现,并与手术所见对照。结果：７例胆囊、十二指肠瘘的超声检查表现：胆管和胆囊内积气;胆囊结构消失和原有胆囊内结石消失;小肠梗阻。结论：胆囊、十二指肠瘘的超声表现具有一定的特征,有助于临床诊断。     

胆囊十二指肠瘘并十二指肠巨大胆石一例

患者　男 ,5 8岁。右上腹间歇性疼痛 5年 ,加重 1个月入院。有慢性胆囊炎、胆石症多年。查体 :慢性消瘦病容 ,皮肤巩膜无黄染 ,肝脾未及 ,脐周压痛 ,肠鸣音亢进。实验室检查无异常。Ｂ超 :胆囊炎 ,胆石症。Ｘ线上消化道钡餐造影 :胃呈鱼钩型 ,十二指肠球部形态正常。胆囊及胆总管显影 ,且胆囊与十二指肠球后部相通 ,透视下动态观察 ,有多个大小不等的卵圆形负影从胆囊进入十二指肠内 ,十二指肠水平段内可见一巨大充盈缺损 ,球形 ,约 10ｃｍ× 10ｃｍ大小 ,其内由大量卵圆形负影组成 ,钡剂通过此处轻度受阻 ,十二指肠蠕动增强 ,但无梗阻 ,空…     

胆囊巨大结石并十二指肠内瘘一例

患者男,75岁。1个月前因暴饮暴食后出现上腹部胀痛,伴恶心、呕吐。无明显发热、胸闷、心悸、咳嗽、腹泻与脓血便等。曾在外院诊断为急性胰腺炎,并给予输液治疗(药物不详)后腹胀、腹痛好转。但进食后仍恶心、呕吐。患者既往有胆囊炎、胆囊结石及胰腺炎病史。腹部CT平扫:示胆囊明显增大,胆囊壁增     

胆囊十二指肠内瘘伴胆石性肠梗阻的CT诊断价值分析

目的:评价螺旋CT对胆囊-十二指肠内瘘伴胆石性肠梗阻的诊断价值。方法:对8例经手术证实为胆囊-十二指肠内瘘伴胆石性肠梗阻的螺旋CT表现及重建技术进行回顾性分析。结果:8例患者中,2例胆石位于十二指肠降段;2例位于空肠;1例位于空回肠交界处;另外3例位于回肠内。胆石短径为(4.70±1.20)cm,长径为(6.09±1.90)cm。胆囊-十二指肠内瘘伴胆石性肠梗阻的CT直接征象主要有瘘口的显示以及胆石位于梗阻段肠腔内;间接征象主要有胆囊及胆道积气;胆囊塌陷及胆囊与十二指肠分界模糊、结构紊乱;肠梗阻。以上两种直接征象若同时存在即可作出诊断,如一种直接征象同时伴有两种或两种以上间接征象亦可作出诊断。结论:胆囊-十二指肠内瘘伴胆石性肠梗阻具有典型的CT表现,螺旋CT能够对其作出明确诊断。     

胆囊十二指肠瘘术前漏诊1例

胆囊十二指肠瘘是胆道疾病中少见的并发症，因其无特异性临床症状，术前不易确诊。我院经手术确诊并治愈1例胆囊十二指肠瘘患者，现报告如下。     

胆囊颈部结石穿孔致胆囊与十二指肠通连畸形1例

1、病例介绍：患者女性57岁。反复右上腹痛3年入院，3年前无明届诱因出现右上腹痛。呈阵发性胀痛、向右肩背部放射，伴厌油腻食物，在当地医院行B超检查示胆囊颈部结石，予消炎利胆结石治疗后症状缓解，随后反复出现，多次复查B超示胆囊颈部结石，入院要求行经腹腔镜胆囊切除术。查体：神清，皮肤黏膜无黄染，浅表淋巴结无肿大，心肺检查正常，腹平坦，右上腹深压痛，无反跳痛，无肌紧张，Murphys征（-），移动性浊音阴性，肠鸣音正常。入院B超检查提示胆囊颈部结石，肝肾功能正常，上消化道钡透考虑十二指肠处少许钡剂存留。做好术前准备行经腹腔镜胆囊切除术，术中见胆囊颈部结石与十二指肠粘连，分离粘连，见有胆汁渗出，术中转开腹，证实为胆囊十二指肠瘘，行胆囊切除，十二指肠修瘘补术，术后10天痊愈出院。     

残余胆囊的超声诊断

残余胆囊系指胆囊切除术后 ,因胆囊颈残留或胆囊残株过长所形成的“小胆囊”。由于病变未能根除或残余胆囊并发炎症 ,结石甚至肿瘤 ,导致术后症状依旧或复发。因此 ,残余胆囊已成为一个不可忽视的问题。本文分析总结了我院 1993 10～1999 10经手术和病理证实的 16例残余胆囊病例资料 ,旨在探讨残余胆囊的诊断及其漏诊原因分析。1　资料与方法1 1　本组病例男 6例 ,女 10例 ,年龄 2 4～ 6 6岁。首次胆囊手术后出现临床症状的时间不等 ,4例术后症状依然存在 ,10例从数月至数年才出现症状。其临床表现为 :右上腹痛 ,腹胀 ,恶心、呕吐等 ,少数患…     

胆囊十二指肠内瘘的CT诊断

目的：探讨MSCT对胆囊十二指肠内瘘的诊断价值。方法：回顾性分析7例胆囊十二指肠内瘘的资料,7例均行MSCT检查,使用ADW 4.5后处理工作站对图像行MPR,分析其特征性影像学表现。结果：7例MSCT直接征象：4例瘘口位于十二指肠球部,3例位于降部;瘘口内径3～19 mm,平均8 mm。间接征象：胆囊形态萎陷、壁增厚（胆囊壁厚5～10 mm,平均8 mm）;胆囊十二指肠局部黏合,轮廓模糊;均有胆道系统积气;胆囊结石异位致机械性肠梗阻（5例梗阻位于十二指肠,2例梗阻位于空肠上段）。结论：MSCT不仅可清晰分辨胆囊与十二指肠间瘘口,还可观察胆囊形态、胆肠粘连、胆系积气、胆石性肠梗阻,对指导临床治疗具有重要价值。     

MSCT对胆囊结石并十二指肠瘘的诊断价值

目的：探讨MSCT对胆囊结石并十二指肠瘘的诊断价值。方法：回顾性分析6例经手术证实的胆囊结石并十二指肠瘘的CT表现。结果：6例患者中,胆囊萎缩4例,胆囊体积增大2例;胆囊内结石4例,胆囊无结石2例;胆囊壁钙化2例,胆囊内积气2例,胆管积气1例;6例胆囊周围结构显示均欠清晰,4例软组织块影包绕胆囊及十二指肠,3例结石性肠梗阻,结石位于回肠末端。结论：MSCT具有较高的密度分辨力及空间分辨力,结合多平面重组及临床资料,可对胆囊结石并十二指肠瘘的诊断提供重要信息。     

Cholecystocolonic fistula: serial CT imaging features

We report the CT imaging findings of an unusual case of cholecystocolonic fistula, which had presented in the emergency department with melena. It is rare for the fistulous communication to occur between gallbladder and the colon. We describe the serial imaging findings, which were diagnostic of this condition.     

Cholecystoduodenal fistula: A complication of inserted self-expandable metallic bilitary stents

We encountered a case of hepatic hilar cholangiocarcinoma resulting in cholecystoduodenal fistula after insertion of self-expandable metallic biliary stents (EMBSs). To our knowledge, there has been no report of cholecystoduodenal fistula after insertion of EMBSs. This case suggests that immediate gallbladder decompression may be necessary if acute cholecystitis occurs after insertion of EMBSs.     

Gallstone in jejunal limb with jejunocolonic fistula 10 years after Roux-en-Y choledochojejunostomy

Roux-en-Y choledochojejunostomy is a common biliary reconstruction procedure.The collection of gallstones in the jejunal limb is a rare complication.Here we present a case of a 61-year-old Chinese female who received Roux-en-Y choledochojejunostomy 10 years ago.Diagnosis of recurrent bile duct stones accompanying infection was made before operation.She also had an abdominal mass which was possibly an intussuscepted colon or a huge fecolith.At laparotomy,an oval stone(5 cm in diameter) and 3 smaller multifaceted stones(2 cm in diameter) were found in the jejunal limb.A fistula between this jejunum and colon was also found.Although the typical manifestations of diarrhea were present,the diagnosis of a biliary colonic fistula was missed before operation.Partial colectomy was performed with the fistulous opening repaired.A T-tube was left in the jejunal limb and the mesocolon aperture was enlarged and revised.Her postoperative convalescence was uneventful.We report this case hoping to sharpen our diagnostic acumen.     

彩色多普勒超声诊断飞行员左冠状动脉-肺动脉瘘一例并文献复习

目的 探讨冠状动脉瘘的影像特征、鉴别诊断及彩色多普勒超声在飞行员改装体检中的医学鉴定价值.方法 分析1例飞行员左冠状动脉-肺动脉瘘超声图像特征并复习相关文献.探讨应用彩色多普勒超声检查在飞行员改装体检中的必要性.结果 彩色多普勒超声显示心底部心肌间走行迂曲的异常血流束,经主肺动脉外侧壁注入肺动脉内.超声诊断:左冠状动脉-肺动脉瘘.飞行结论:改装并原机种飞行不合格结论彩色多普勒超声检查能清晰显示冠状动脉瘘,并能追踪观察其走行、部位、内径和大小,超声诊断与冠状动脉造影结果相符.冠状动脉瘘早期无特异性临床表现,彩色多普勒超声心动图诊断冠状动脉瘘直接、安全、快捷,具有重要的临床价值,是明确诊断的首选方法.     

Postcatheterization arteriovenous fistula: CT, ultrasound, and arteriographic findings

The most common etiology of arteriovenous fistulae (AVF) in the lower extremity is iatrogenic, usually from diagnostic or therapeutic angiographic procedures. The finding of a palpable groin thrill, early venous opacification on contrast-enhanced abdominal-pelvic CT, and typical findings on duplex ultrasonography establish the diagnosis. Anatomic confirmation is then made by arteriography. A case of an incidentally discovered AVF in patient presenting to the Emergency Department is presented. Radiographic findings concerning and subsequent management of this patient are then discussed. Electronic Publication     

Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula

Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children. Electronic Publication     

Arteriovenous fistula as a complication of lumbar disc surgery: case report

Arteriovenous fistula (AVF) is a rare, late complication of lumbar disc surgery. It is often not suspected and the symptoms are diagnosed as heart failure or deep venous thrombosis. We report a case in which the patient developed leg swelling and high-output congestive heart failure due to a left ilioiliac AVF after lumbar laminectomy. Received: 3 September 1997 Accepted: 27 October 1997