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1.
放射性核素显像诊断婴儿肝炎综合征和先天性胆道闭锁 总被引:3,自引:0,他引:3
放射性核素显像诊断婴儿肝炎综合征和先天性胆道闭锁黄志华,董永绥,吴华,赵明婴儿持续性黄疸的病因诊断一直是临床相当棘手的问题,其中以婴儿肝炎综合征(IHS)和先天性肝外胆道闭锁(EHBA)两者的早期鉴别甚为重要。近年来,放射性核素的研究进展,使99m锝... 相似文献
2.
回顾性评价了经手术或尸检诊断的11例胆道闭锁和随访了26例黄疸消失的婴儿肝炎综合征患儿十二指肠液的颜色,放射性核素肝胆显像,B超肝胆检查结果,以十二指肠液透明无色诊断胆产闭锁,十二指肠黄色诊断婴儿肝炎综合征,正确率为94.6%,以肠道有无效放射性示踪剂来鉴别胆道闭锁与婴儿肝炎综合征,正确率为81.1%,B超声波肝胆检查有无胆囊鉴别胆道闭锁与婴儿肝炎综合征,正确率为78.0%,结果表明,观察十二指肠 相似文献
3.
回顾性评价了经手术或尸检诊断的11例胆道闭锁和随访了26例黄疸消失的婴儿肝炎综合征患儿十二指肠液的颜色、放射性核素肝胆显像、B超肝胆检查结果.以十二指肠液透明无色诊断胆道闭锁,十二指肠液黄色诊断婴儿肝炎综合征,正确率为94.6%.以肠道有无放射性示踪剂来鉴别胆道闭锁与婴儿肝炎综合征,正确率为81.1%.B型超声波肝胆检查有无胆囊鉴别胆道闭锁与婴儿肝炎综合征,正确率为78.0%.结果表明,观察十二指肠液颜色是简单、快速、可靠的鉴别方法. 相似文献
4.
本研究了24例婴儿持续性黄^99mTc二乙基乙酰苯胺亚氨二醋酸(EHIDA)肝胆显像的结果,认为该方法对排除肝外先天性胆道闭锁(EHBA)具有特异性,是鉴别婴儿肝炎综合征(IHS)和肝外胆道闭锁(EHBA)是一种可靠,安全,简便而实用的方法。 相似文献
5.
阻塞性黄疸是由于胆道阻塞,阻塞上方压力增高,胆管扩张,最后导致小胆管与毛细胆管破裂,胆汁中胆红素反流入血所致。超声检查对肝外胆管阻塞引起的黄疸与肝内胆汁淤积所致黄疸的鉴别诊断很有帮助,对肝外胆管阻塞的病因、病变的部位能作出有价值的判断。1 材料和方法11 临床资料:本组80例病例均系我院1998~2000年经我科诊断住院手术患者,男性37例,女性43例,平均年龄375岁,临床表现上腹胀痛、皮肤巩膜黄染、皮肤搔痒、尿色深、粪便颜色变浅或呈白陶土色,部分患者伴畏寒、发热。12 检查方法:采用东芝SSA—240A、东芝SSA—340A超声诊… 相似文献
6.
研究56例无胆道扩张的新生儿及婴儿梗阻性黄疸的临床特点及外科手术时机及效果。超声证实无肝内外胆道扩张的新生儿及婴儿梗阻性黄疸,均行手术探查及病理学检查。手术证实56例梗阻性黄疸中有30例为胆汁粘稠症,并经胆道冲洗治愈;26例为胆道闭锁,预后不良。二者在肝内小胆管增生这一病理改变上存在一一致性,可能是对胆道梗阻的代偿机制之一。 相似文献
7.
探讨淤胆型婴儿肝炎综合征(IHS)与肝外胆道闭锁(EHBA)鉴别诊断程序。根据病史采用婴儿十二指肠引流术进行十二指肠液检查,若十二指肠液白色或十二指肠液总胆红素<8.5μmol/L,则行99mTc-亚氨基二乙酸(EHIDA)肝胆显像和B型超声波肝胆检查,若肠道无显像和无胆囊时,再次行动态持续十二指肠液检查。动态持续十二指肠液检查、十二指肠液白色或十二指肠液总胆红素<8.5μmol/L,99mTc-EHIDA检查无肠道显像和B超检查无胆囊诊断为EHBA,与手术探查结果一致。IHS与EHBA鉴别诊断程序具有实用价值。 相似文献
8.
农有弟 《华北煤炭医学院学报》2002,4(1):86-87
梗阻性黄疸,肝内胆管节段性扩张的诊断与治疗,是临床较常见且注重研究的课题,黄疸症状常见,病因较多,表现复杂多变,诊断及鉴别是临床一大难题,而B超检查是诊断的主要手段之一。为提高梗阻性黄疽及肝内胆管节段性扩张诊断率;提高定性、定位诊断及手术切除率。1995~2000年我们对梗阻性黄疸住院患者32例进行B超影像学研究,报告如下。1 资料与方法1.1 一般资料 梗阻性黄疸32例,男12例,女20例;年龄23~60岁,平均41.9岁。32例患者在检查前均出现不同程度黄疸。肝内胆管节段性扩张5例,男2例,女… 相似文献
9.
原发性硬化性胆管炎诊治的探讨 总被引:1,自引:1,他引:0
文章报导该院自1986~1995年收治的原发性硬化性胆管炎20例,其中男性16例,女性4例,平均年龄44岁。从出现症状至确诊平均病程2年,阻塞性黄疸是该组病人的突出表现。诊断主要依靠直接胆道造影,如胆管纤细,枯树枝状,串珠状,剪枝状或跳跃节段状,水中胆道病理检查可以与胆管癌鉴别。硬化性胆管炎应该早期治疗,主要手术方式是胆管空肠Rouxy吻合加肝内胆管U管引流,胆管的支撑管应停留1年以上。本病最终会引起胆汁性肝硬化,终末期可选择肝移植。 相似文献
10.
探讨阻塞性黄疸的病因及诊断。方法对1204例阻塞性黄疸进行临床分析。结果良性梗阻970例(81%),其中胆总管结石952例,胆总管狭窄12例,Oddis括约肌狭窄4例;恶性梗阻234例,其中胆管癌99例,胰头癌77例,十二指肠乳头癌34例,胆囊癌14例,肝癌10例,胆总管囊肿1例,十二指肠结核1例。结论对阻塞性黄疸,通过B超、CT、经皮肤肝穿刺胆管造影术、内窥镜逆行胰胆管造影术等检查,了解阻塞部位、病因及诊断 相似文献
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The different methods in differentiating biliary atresia (BA) from non-BA-related cholestasis were evaluated in order to provide a practical basis for a rapid, early and accurate differential diagnosis of the diseases. 396 infants with cholestatic jaundice were studied prospectively during the period of May 2007 to June 2011. The liver function in all subjects was tested. All cases underwent abdominal ultrasonography and duodenal fluid examination. Most cases were subjected to hepatobiliary scintigraphy, magnetic resonance cholangiopancreatography (MRCP) and a percutaneous liver biopsy. The diagnosis of BA was finally made by cholangiography or histopathologic examination. The accuracy, sensitivity, specificity and predictive values of these various methods were compared. 178 patients (108 males and 70 females with a mean age of 58±30 days) were diagnosed as having BA. 218 patients (136 males and 82 females with a mean age of 61 ±24 days) were diagnosed as having non-BA etiologies of cholestasis jaundice during the follow-up period in which jaundice faded after treatment with medical therapy. For diagnosis of BA, clinical evaluation, hepatomegaly, stool color, serum gamma-glutamyltranspeptidase (GGT), duodenal juice color, bile acid in duodenal juice, ultrasonography (gallbladder), ultrasonography (griangular cord or strip-apparent hyperechoic foci), hepatobiliary scintigraphy, MRCP, liver biopsy had an accuracy of 76.0%, 51.8%, 84.3%, 70.0%, 92.4%, 98.0%, 90.4%, 67.2%, 85.3%, 83.2% and 96.6%, a sensitivity of 83.1%, 87.6%, 96.1%, 73.7%, 90.4%, 100%, 92.7%, 27.5%, 100%, 89.0% and 97.4%, a specificity of 70.2%, 77.5%, 74.8%, 67.0%, 94.0%, 96.3%, 88.5%, 99.5%, 73.3%, 75.4% and 94.3%, a positive predictive value of 69.0%, 72.6%, 75.7%, 64.6%, 92.5%, 95.7%, 86.8%, 98.0%, 75.4%, 82.6% and 98.0%, and a negative predictive value of 83.6%, 8.5%, 95.9%, 75.7%, 92.3%, 100%, 84.2%, 93.7%, 100%, 84.0% and 92.6%, respectively. It was concluded that all the differential diagnosis methods are useful. The test for duodenal drainage and elements is fast and accurate. It is helpful in the differential diagnosis of BA and non-BA etiologies of cholestasis. It shows good practical value clinically. 相似文献
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13.
The common causes of infantile persistent choles-tatic jaundice are infantile hepatitis syndrome (IHS) and extrahepatic biliary atresia (EHBA)[1]. The differential diagnosis between IHS and EHBA is very difficult be-cause there is considerable clinical, biochemical, and histopathologic overlaps between them. Magnetic reso-nance cholangiography (MRC) is a newly-established non-invasive modality used for the diagnosis of EHBA in infants. Their results varied on the accuracy, sensitiv-ity… 相似文献
14.
彩色多普勒超声引导下经皮经肝肝内胆管置管引流55例的临床分析 总被引:1,自引:0,他引:1
苗润琴 《世界中西医结合杂志》2009,4(3):198-199,202
目的探讨彩色多普勒超声引导经皮经肝胆道置管引流在恶性肿瘤所致阻塞性黄疸中的临床应用价值。方法对55例恶性肿瘤引起的阻塞性黄疸患者,在超声引导下做经皮经肝胆道置管引流术。结果55例患者中,50例置管引流成功,成功率为90.9%。1w后50例黄疸明显减退,减退率为100%。结论超声引导经皮经肝胆道置管引流是对恶性肿瘤所致阻塞性黄疸患者术前减轻黄疸及姑息性治疗的有效方法,其操作方法值得深入探讨及掌握。 相似文献
15.
Kinoshita H Hashimoto M Sajima S Sato S Furukawa S Kawabata M Hashino K Sakai T Tamae T Fukuda S Hara M Imayama H Aoyagi S 《The Kurume medical journal》2000,47(3):229-233
We present a patient with duodenal papillary carcinoma who repeatedly developed acute pancreatitis preoperatively. The patient was a 65-year-old male. In February 1997, the patient consulted a local hospital due to vomiting, high fever, and jaundice. With the diagnosis of obstructive jaundice, percutaneous transhepatic biliary drainage (PTBD) was performed, revealing a distal bile duct obstruction. Because duodenal papillary carcinoma was diagnosed based on endoscopic findings, the patient was admitted to Kurume University Hospital. Hypotonic duodenography (HDG) disclosed a protruding lesion with an irregular surface in the descending part of the duodenum, resulting in a diagnosis of positive duodenal invasion (du1). Because computed tomography (CT) demonstrated a protruding lesion on the medial side of the second portion of the duodenum, positive pancreatic invasion (panc2) was diagnosed. On March 18 and April 22, sudden abdominal pain, leukocytosis, and an increase in serum amylase were noted. CT revealed that the pancreas was diffusely enlarged, showing an ill-defined boundary between the pancreas and adipose tissue and fluid collection. On CT, the lesion was evaluated as Grade 3 and moderate. For treatment, pancreatic enzyme inhibitors and antibiotics were intravenously injected. Peritoneal perfusion was concomitantly performed during the second treatment. Because symptoms remitted thereafter, a pylorus preserving pancreatoduodenectomy (PpPD) was carried out. The postoperative histologic examination revealed negative pancreatic invasion. Concerning the etiology of acute pancreatitis, not pancreatic invasion, but impaction of the liberated tumor mass in the common canal was considered responsible for the repeated pancreatitis because the tumor showed a cauliflower-like shape. 相似文献
16.
目的:总结十二指肠肿瘤的临床特点,探析十二指肠肿瘤的诊治方法。方法:回顾性分析我院20092013年间收治的65例十二指肠肿瘤患者的临床资料。结果:十二指肠肿瘤最常见的临床表现为上腹痛或上腹部不适、黄疸、呕血或黑便、呕吐、发热。内镜检查是诊断十二指肠肿瘤的主要手段,联合影像学检查可提高诊断阳性率。手术是十二指肠肿瘤最有效的治疗方法。结论:十二指肠肿瘤临床症状缺乏特异性,联合检查可提高诊断阳性率,外科手术及内镜下治疗是十二指肠肿瘤的主要治疗方式。 相似文献
17.
目的探讨MRI动态增强扫描(LAVA)联合磁共振胰胆管造影(MRCP)对胆道梗阻性疾病的诊断价值。方法选取2010-07-01—2011-05-01我院收治的40例梗阻性黄疸患者,均行LAVA、MRCP检查,对良恶性胆道梗阻的LAVA、MRCP影像学特征进行回顾性分析。结果 LAVA、MRCP检查显示:40例梗阻性黄疸患者中,末端胆管癌13例,肝门胆管癌5例,胰头癌4例,十二指肠癌2例,壶腹癌1例,十二指肠憩室炎1例,胆管结石12例,胰腺导管内乳头状黏液瘤2例。结论 LAVA和MRCP的联合应用对胆道梗阻性疾病的鉴别诊断具有重要价值,其影像学结果对临床治疗决策有指导意义。 相似文献
18.
目的:探讨腹腔镜下行胆总管探查一期缝合术的可行性。方法:对30例胆总管结石患者行腹腔镜下胆总管探查一期缝合术。结果:术后发生胆漏2例,其余病人术后恢复顺利,未出现腹痛、黄疸等并发症,引流管拔出时间2~3d。结论:胆总管结石行腹腔镜下胆总管切开取石一期缝合是可行的,但必须强调严格掌握手术适应证。 相似文献
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目的 研究恶性梗阻黄疸患者接受经皮穿肝胆管支架置入后发生早期胆道感染的危险因素,探讨可行治疗方案。方法 观察128例恶性梗阻黄疸患者行支架置入术后1个月内发生胆道感染情况。应用单因素及多因素分析法针对相关危险因素进行统计学分析。结果 128例患者引流成功率71.1%(91/128),早期胆道感染发生率30.4%(39/128)。年龄、致胆管狭窄类型、梗阻部位、黄疸持续时间、支架位置及术后胆红素下降比为差异具有统计学意义的危险因素,后3者为独立危险因素。支架跨过十二指肠大乳头患者引流成功率高82.5%(47/57),早期胆道感染发生率19.2%(11/57)低于未跨过组38.0%(28/71),差异有统计学意义(χ2=6.053,P =0.014)。结论 经皮穿肝胆管支架置入术针对恶性梗阻黄疸患者减黄效果稳定、操作安全。支架跨过十二指肠大乳头能够迅速减黄从而降低早期胆道感染发生率。
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