胆囊术后并发症的临床和多层螺旋CT分析

目的：探讨胆囊切除术后并发症的 MSCT 表现及临床诊断价值。方法：回顾性分析22例腹腔镜胆囊切除术（LC）或开腹胆囊切除术（OC）后发生并发症患者的临床特点及 CT 表现。结果：22例共29例次胆囊术后并发症,其中胆系并发症共18例：包括肝胆管损伤11例次,MSCT 主要表现为胆囊窝区渗出性改变及腹腔包裹性积液;胆-肠吻合口狭窄3例次,MSCT 示肝内胆管不同程度扩张,多平面重组（MPR）图上可见狭窄的吻合口;胆总管内残余结石3例次;残余胆囊管伴结石1例次。非胆系并发症11例次：包括血管损伤2例次,MSCT 门静脉成像示门静脉主干狭窄并广泛侧支循环形成;早期急性胰腺炎2例次;腹壁切口感染2例次;腹腔感染3例次,MSCT 上表现为不同程度的腹膜增厚并腹腔积液;腹壁切口疝2例次,MSCT 示大网膜及部分肠管自腹壁切口处疝出至腹壁下。临床诊断与 MSCT 诊断结果的符合率为86．21％,其中胆系和非胆系并发症分别为83．33％和90．91％。术后7天内肝内胆管损伤的发生率最高（11／18）;1周～1个月内,早期急性胰腺炎发生率最高（2／5）;1个月～1年,胆肠吻合口狭窄的发生率最高（3／4）;＞1年,腹壁切口疝的发生率最高（2／2）。结论：MSCT 能对胆囊切除术后并发症进行较为全面、准确的影像学评价。了解胆囊术后并发症的临床及影像学特点,有助于提高诊断准确性。     

肝硬化门静脉高压侧枝血管的多层螺旋CT表现

目的用多层螺旋CT(MSCT)统计、分析肝硬化门静脉高压患者的侧枝循环表现。方法收集203例肝硬化门静脉高压患者MSCT上腹部检查的完整资料。结果共发现门静脉侧枝或异常血管612处:食管下段静脉曲张175处,食管旁静脉曲张49处(其中伴假肿瘤征13处),胃底静脉曲张119处,胃冠状静脉曲张105处,胃肾静脉分流34处,脾肾静脉分流15处,椎旁静脉丛曲张16处,脐静脉再通48处,副脐静脉再通22处,脐静脉、副脐静脉同时再通4处,腹壁静脉丛曲张呈蛇头征12处,门静脉海绵样变8处,门静脉右后支瘤样扩张并与下腔静脉分流4处,胃左静脉直接入肝与门静脉左支相连1处。结论MSCT可较好地显示各类门静脉高压侧枝,了解这些异常表现有助于作出正确诊断,避免误诊,对临床选择治疗方法有重要的意义。     

经皮治疗门静脉血栓的临床研究

目的：研究和评价经皮治疗门静脉血栓技术的可行性和临床效果。材料与方法：16例有门静脉闭塞症状的患者,门静脉血栓均为非海绵状血管变性所致。通过建立经颈列脉肝内门腔静脉分流通道（TIPS）,带膜支架旁路术和经皮抽吸取栓法清除门静脉血栓提高门静脉的血流输出量。结果：13例采用经皮技术治疗获得成功。门静脉血栓所致的门脉高压均得到纠正,静脉曲张破裂出血立即停止;顽固性腹水和黄疸症状得到缓解。结论：经颈静脉门腔静脉分流术,门静脉内带膜支架旁路术和经皮门静脉抽吸取栓法对于治疗非海绵状血管变性和晨瘤栓所致的门静脉闭塞是安全有效的。     

肝硬化肝内外门-体循环交通的CT表现

目的探讨肝硬化门静脉高压肝内外门-体循环交通的发生率及CT表现特点。方法回顾性分析80例肝硬化门脉高压患者的肝内外门-体交通的螺旋CT三期扫描表现。结果肝外型门-体循环交通见于79例（98．75％），其中，食管下段黏膜下及食管周围静脉曲张48例（60％），奇静脉和半奇静脉扩张28例（35％），小网膜静脉曲张46例（57．5％），副脐静脉肝外型再通20例（25％），脾肾静脉和胃肾静脉分流10例（12．5％），腹膜后椎旁静脉曲张14例（17．5％）；肝内型门-体循环交通6例（7．5％），其中，5例为门静脉左支与副脐静脉交通型（6．25％），1例为门静脉右后支与下腔静脉交通型（1．13％）。结论螺旋CT三期扫描对肝硬化门静脉高压侧支循环的显示有独特的价值，不仅能显示侧支循环的部位、范围和曲张的程度，而且可以追踪血流异常途径。认识侧支循环的CT表现特点，有助于肝内外疾病的鉴别诊断。     

肝门胆管癌的MSCT与MRI诊断

目的：探讨MSCT、MRI及MRCP对肝门胆管癌的诊疗价值。方法：收集18例肝门胆管癌患者,全部病例行MSCT检查,其中8例同时行MRI及MRPC检查。结果：18例中浸润型9例,结节型6例,乳突型3例。直接征象表现为胆管壁不规则增厚及狭窄、肝门区结节或肿块、乳头状或息肉状向腔突出的小结节。18例中,平扫发现可疑直接征象9例,增强扫描18例全部显示清晰,病灶从轻到中度强化,均有延迟期持续强化。8例MSCT、MRI及MRCP对比：MRI平扫发现1例,CT平扫未能发现的肝门结节;MRCP发现2例,CT及MRI平扫未能显示的管壁浸润,4例肝门结节MRCP均未能显示。间接征象主要有：①18例均有肝门病灶区以上肝内胆管扩张,呈弥漫性柱状、“软藤状”、“蟹足状”或囊状;4例累及一侧胆管为局部胆管扩张;扩张胆管由肝门向外周延伸,胆总管无扩张;②3例受累侧肝叶萎缩;③4例肝叶局部受侵及肝门血管被包饶;④5例肝门淋巴结转移。结论：MSCT、MRI及MPCP对诊断肝门胆管癌有重要价值,三种方法结合运用,能明显提高诊断率,对临床确定治疗方案可提供准确有效的依据。     

64层螺旋CT门静脉造影在显示肝硬化门静脉高压侧支循环中的价值

目的：评价64层螺旋CT门静脉造影对肝硬化门静脉高压侧支循环显示的价值.材料和方法：肝硬化患者28例,采用64层螺旋CT行动脉期、门脉期及平衡期扫描后,运用容积重建法（VR）、多层面重建法（MPR）和最大密度投影法（MIP）对门静脉及其分支进行重建,观察门静脉高压肝内门静脉、属支及侧支循环的影像学特征.结果：64层螺旋CT门静脉造影能准确显示侧支循环分布范围,初步评估病变程度;门静脉高压时,门静脉属支管径显著扩张（门静脉主干、脾静脉、肠系膜上静脉、胃冠状静脉）.胃冠状静脉曲张24例、食管胃底静脉曲张21例、食管周围静脉曲张17例、胃短静脉曲张10例、脾/胃-肾分流6例、脐静脉和腹壁静脉曲张5例、腹膜后静脉曲张2例和直肠上静脉曲张2例,门静脉海绵状变性1例.结论：64层螺旋CT门静脉造影能够多角度、准确地显示门静脉高压时侧支循环开放的情况,对判断病变程度、预测其并发症、选择治疗方案具有重要意义.     

TIPSS术＋食道胃底静脉曲张栓塞术前后门静脉压力的变化

目的观测肝硬化门静脉高压患者行经颈内静脉肝内门体分流术（transjugular intrahepatic portosystemic stent shunt,TIPSS）＋食道胃底静脉曲张栓塞术前后门静脉压力的变化,进而探讨TIPSS＋食道胃底静脉曲张栓塞术在治疗肝硬化门静脉高压中的作用。方法对20例因肝硬化所致门静脉高压患者行经颈内静脉肝内门体分流术＋食道胃底静脉曲张栓塞术,在术前、术后分别用直接法测定门静脉主干压力,比较术前、术后压力的变化。结果术前本组肝硬化门脉高压患者的门静脉压力为（41.46±4.89）cmH2O、术后为（25.65±5.73）cmH2O,差异有显著性（P〈0.001）。术前、术后压力差为（15.82±3.12）cmH2O,术后较术前门静脉压力平均下降38.13%。结论 TIPSS＋食道胃底曲张静脉栓塞术可显著降低肝硬化门脉高压患者的门静脉压力,在治疗肝硬化门脉高压症中有重要的应用价值。     

自身免疫性肝炎致肝硬化的MRI表现及其临床价值

目的 探讨自身免疫性肝炎(autoimmune hepatitis,AIH)致肝硬化的MRI诊断特点,以提高其诊断准确性.资料与方法回顾分析经临床确诊为AIH所致肝硬化患者7例,所有患者均按肝功能Child-Pugh分级(A级2例,B级2例,C级3例)并行MR T,WI、T2WI、扩散加权成像(DWI)及动态增强扫描.2例行肝穿刺活检,2例经1～2年随访,分析其MRI表现并与病理、肝功能分级对照.结果 (1)肝脏形态学改变:5例(Child B、C级)全肝萎缩.3例(Child C级)肝脏内可见多个大小不等结节形成,可见结节融合,横径最大约为53 mm,结节信号表现多样,但在DWI上均呈低信号,部分结节增强后可见强化,随访后强化信号消失.(2)继发门静脉高压改变:除1例(Child A级)无明显继发门静脉高压表现,余6例门静脉主干增粗、胃底及脾静脉延长迂曲.7例脾均增大,2例(Child C级)脾内可见含铁血黄素沉积,其中1例伴有脾梗死.3例(Child C级)腹腔积液形成.(3)其他:1例(Child A级)肝内胆管轻度扩张.所有患者均无淋巴结改变.肝穿刺病理结果符合AIH致肝硬化表现.结论 AIH致肝硬化的MRI表现特点为:随着肝功能Child-Pugh分级的加重,肝脏形态学及继发门静脉高压改变随之加重;全肝萎缩,肝左外叶及尾状叶的代偿性增大少见;肝硬化结节形态、信号改变多样,癌变罕见;可伴有肝内胆管扩张;较少伴有淋巴结肿大.MRI可作为AIH致肝硬化的有效检查手段.     

多层螺旋CT及其门静脉造影在TIPS联合胃冠状静脉栓塞术前应用价值

目的：探讨多层螺旋CT（MSCT）及多层螺旋CT门静脉造影（MSCTP）在经颈静脉肝内门体分流（TIPS）联合胃冠状静脉栓塞（GCVE）术前应用的价值。方法对126例肝硬化门静脉高压伴发食管胃底静脉曲张破裂出血或顽固性腹水拟行TIPS联合GCVE患者,术前行MSCT及MSCTP检查。采用最大密度投影（MIP）、多平面重组（MPR）、遮蔽表面显示（SSD）和容积再现（VR）等后处理技术全面了解肝脏情况。结果 MSCT及MSCTP能清晰显示肝硬化肝脏形态变化、肝静脉与门静脉空间位置关系、门静脉侧支循环开放程度和范围以及腹水等情况,为TIPS联合GCVE术前评估提供了重要的解剖信息。结论 MSCT 及MSCTP 是无创性检查并明确诊断肝硬化门脉高压症的可靠方法,对 TIPS 联合GCVE术中准确引导门静脉穿刺及曲张静脉栓塞治疗具有重要指导意义。     

常染色体隐性遗传性多囊肾病:临床、病理与影像学表现

常染色体隐性多囊肾病是一种以肾集合管和肝内胆管扩张、畸形及肝脏和肾脏纤维化为特点的遗传性疾病。高血压、肾功能不全及门静脉高压是常见的临床症状。影像学表现为肾脏增大但保持肾的外形，超声显示肾实质呈弥漫性回声，静脉肾盂造影及增强CT显示肾脏呈纹状改变。肝脏影像学表现可正常或肝内胆管扩张，门静脉高压常表现脾脏增大和门静脉曲张.     

Magnetic resonance cholangiography features of biliary abnormalities due to cavernous transformation of the portal vein

BACKGROUND: The aim of this retrospective and monocentric study was to describe the magnetic resonance cholangiography (MRC) features of biliary abnormalities related to extrahepatic obstruction of the portal vein (EHOPV). METHODS: From September 2001 to May 2003, MRC was performed in 10 consecutive patients who had a portal thrombosis. RESULTS: Biliary ductal pathology was demonstrated via MRC in nine patients. It consisted of stenoses, ductal narrowing or irregularities involving the common bile duct for three patients with extrahepatic portal vein thrombosis discovered a mean of 1.5 years ago, or involving both right and left intrahepatic bile ducts and common bile duct for six patients with extrahepatic portal vein thrombosis discovered a mean of 16.2 years ago. Dilation of intrahepatic bile ducts was seen for seven patients, four of them having cholestasis. For three patients with symptomatic cholestasis, direct cholangiography (DC) was performed and showed the same findings as MRC which nevertheless overestimated the degree of bile duct stenosis. CONCLUSIONS: MRC seems to constitute an accurate tool to investigate noninvasively patients with portal biliopathy.     

Biliary abnormalities associated with portal biliopathy: evaluation on MR cholangiography

OBJECTIVE: The purpose of our study was to evaluate the MRI features of portal biliopathy. CONCLUSION: MR cholangiography coupled with dynamic 3D gradient-echo imaging could not only detect portal vein occlusion, cavernous transformation, and gallbladder varices but is also suitable for delineating associated bile duct abnormalities.     

Portal biliopathy: imaging manifestations on multidetector computed tomography and magnetic resonance imaging

Portal biliopathy refers to biliary abnormalities secondary to extrahepatic portal vein obstruction and cavernous transformation and is caused by vascular compression from peribiliary collateral vessels, producing segmental stenoses of the common bile duct and abnormal liver function test (LFT) results. A review of imaging studies yielded 18 patients with abnormal LFT results, biliary tract dilatation, and extrahepatic portal vein obstruction with cavernous transformation. Multidetector computed tomography and magnetic resonance imaging showed biliary stenotic segments in 11 patients secondary to extrinsic compression from enlarged peribiliary collaterals. Clinical and imaging follow-up demonstrated improvement in LFT results with minimal decrease in bile duct dilatation, eliminating percutaneous or endoscopic biliary intervention.     

肝吸虫性胆管炎的CT表现与误诊分析

目的：探讨肝吸虫性胆管炎的CT表现特点及误诊原因。方法：本组48例临床表现急性胆管炎的肝吸虫病例行螺旋CT检查,并对照逆行性胰胆管造影加内镜下奥狄括约肌切开术和胆总管探查术结果进行回顾性分析。结果：肝内胆管扩张48例,末梢胆管囊状扩张38例;肝外胆管扩张32例和胆总管壁增厚12例,胆总管内高密度影6例;胆囊增大20例,胆囊内団状软组织影2例。本组15例术前CT误诊,其中误诊为胆管结石8例,因胆总管壁增厚并有强化而误诊胆总管下端癌4例和壶腹癌1例,误诊为肝内周围型胆管癌2例。结论：在肝吸虫疫区,当CT表现为胆管炎征象并伴有肝包膜下小胆管囊状扩张时,需要考虑吸虫所致。     

Cholangiopathy in extrahepatic portal venous obstruction. Radiological appearances

PURPOSE: To evaluate cholangiographic abnormalities resulting from extrahepatic portal venous obstruction (EHPVO) by sonography and endoscopic retrograde cholangiopancreaticography (ERCP). MATERIAL AND METHODS: Forty-three patients with an established diagnosis of EHPVO were subjected to duplex Doppler sonography and ERCP. Of these, 8 patients had obstructive jaundice. RESULTS: Dilated common bile duct with pericholedochal varices showing a continuous type of flow pattern was seen in 5 EHPVO patients with obstructive jaundice. ERCP revealed cholangiographic abnormalities in 40 patients (93%). Extrahepatic bile ducts were involved in 100% of cases compared to intrahepatic bile ducts (57%). Abnormalities noted were contour irregularity with indentations, displacement and angulation, strictures and filling defects in the extrahepatic ductal system. Intrahepatic bile ducts showed dilatation with areas of narrowing and filling defects. CONCLUSION: Cholangiographic abnormalities are very common in patients with EHPVO, even without clinical manifestations of biliary disease. Extrahepatic bile ducts are far more often involved compared to intrahepatic bile ducts. Extrinsic compression with contour irregularity is the most common cholangiographic finding. Sonographic findings are not diagnostic. Dilated common bile duct with pericholedochal varices was seen in only 5 patients.     

阴性法64层CT胆胰管成像在胆道闭锁中的诊断价值

目的：总结分析胆道闭锁的阴性法64层CT胆胰管成像（N—CTCP）的影像表现,探讨其诊断价值。方法：回顾性分析临床疑诊为胆道闭锁的52例患儿的影像资料,全部患儿行腹部增强CT门脉期扫描后采用容积重建（VR）、多平面重建（MPR）及最小密度投影（MinlP）等技术进行重建,观察并比较患儿肝内外胆道、肝门部结构、胆囊、肝脏、脾脏大小等征象的显示情况。结果：32例经手术病理证实为胆道闭锁（BA组）,20例临床确诊为婴儿肝炎综合征（IHS组）。胆道闭锁的N—CTCP影像特征包括：无或小胆囊、肝门区三角形低密度区、门静脉间隙增宽,可见“双边征”或“靶征”。BA组无1例显示胆总管,4例左、右肝管可见,但管道不连续,20例出现肝、脾肿大。小胆囊、三角征及门静脉间隙增宽在IHS组与BA组中差异有统计学意义（P〈O．05）,肝外胆管不显示、肝脾肿大在IHS组与BA组间差异无统计学意义（P〉0．05）。结论：胆道闭锁的N—CTCP表现具有一定特征性,肝门区三角形低密度影、小胆囊、门静脉间隙增宽出现“双边征”或“靶征”是诊断BA的重要征象。     

胰腺实性-假乳头状瘤的MSCT诊断价值

目的：分析胰腺一实性假乳头状瘤的MSCT表现,提高其术前诊断率。方法：回顾分析经手术及病理证实的8例胰腺实性一假乳头状瘤的CT表现。结果：①8例均呈囊实性结构,囊性成分多于实性成分;实性部分及包膜CT平扫表现为低密度或等密度影,动脉期轻度强化,门脉期明显强化;囊性部分始终未强化;②1例伴有肝内外胆管明显扩张,胰管未扩张。结论：胰腺实性-假乳头状瘤的MSCT表现有一定的特异性,MSCT对其诊断和鉴别诊断具有重要价值。     

多层螺旋CT在肝外胆管梗阻病变诊断中的应用

目的：探讨多层螺旋CT（MSCT）在肝外胆管梗阻病变中的应用价值。方法回顾性分析经手术、病理以及临床随访证实的均做了CT检查的肝外胆管梗阻病变51例,其中良性41例,恶性10例。结果肝外胆管梗阻性病变中,良性多表现为肝内胆管呈枯枝状或残根状轻、中度扩张,梗阻部胆管呈漏斗样改变,肝外胆管壁呈环形弥漫性增厚;恶性多表现为肝内胆管呈软藤状中、重度扩张,梗阻部胆管呈截断型或突然狭窄并伴肿块,肝外胆管壁呈环形局限性增厚。结论良恶性肝外胆管梗阻病变均有其特征性的CT征象,注意观察胆管的形态改变,以及与周围组织结构的关系,结合临床综合分析,有助于提高诊断的准确性。     

Portal Vein Stenting for Portal Biliopathy with Jaundice

Portal biliopathy refers to obstruction of the bile duct by dilated peri- or para-ductal collateral channels following the main portal vein occlusion from various causes. Surgical shunt operation or endoscopic treatment has been reported. Herein, we report a case of portal biliopathy that was successfully treated by interventional portal vein recanalization.     

Stent Recanalization of Chronic Portal Vein Occlusion in a Child

An 8-year-old boy with a 21/2 year history of portal hypertension and repeated bleedings from esophageal varices, was referred for treatment. The 3.5-cm-long occlusion of the portal vein was passed and the channel created was stabilized with a balloon-expandable stent; a portosystemic stent-shunt was also created. The portosystemic shunt closed spontaneously within 1 month, while the recanalized segment of the portal vein remained open. The pressure gradient between the intrahepatic and extrahepatic portal vein branches dropped from 17 mmHg to 0 mmHg. The pressure in the portal vein dropped from 30 mmHg to 17 mmHg and the bleedings stopped. The next dilation of the stent was performed 12 months later due to an increased pressure gradient; the gastroesophageal varices disappeared completely. Further dilation of the stent was planned after 2, 4, and 6 years.