MRCP在肝外胆管梗阻中的诊断价值

目的探讨磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)技术在肝外胆管梗阻中的诊断价值。方法收集我院2004年收治的42例胆管梗阻患者的MRCP检查临床资料．分析良、恶性肝外胆管梗阻在MRCF，上的不同表现。结果MRCP检查在30例良性梗阻患者主要表现为胆管均匀扩张及逐渐狭窄．管壁均匀增厚．断端可呈“鸟嘴样”，其在良性梗阻中的定位及定性准确率分别为100％(30／30)和97％(29130)；12例恶性梗阻患者中主要表现为胆管不均匀对称扩张及突然狭窄或截断，管壁不均匀增厚，可出现“双管截断征”，其在恶性梗阻中的定位及定性准确率分别为100％(12／12)和92％(11／12)。结论MRCP是一种无创性显示胰胆管管腔形态学改变的影像学方法，在评价肝外胆管梗阻中具有较好的定位及定性准确率。     

肝外胆管梗阻性疾病的MRCP诊断价值

目的探讨磁共振胆胰管成像技术对肝外胆管梗阻性疾病的诊断价值。方法对52例经病理或随访证实的肝外胆管梗阻性疾病患者的MRCP资料进行回顾性分析,总结良恶性肝外胆管梗阻的不同MRCP表现。结果52例中,MRCP均能够准确测定胆管扩张程度和梗阻的水平,其中良性梗阻27例,MRCP主要表现为胆管均匀扩张及逐渐狭窄,肝外胆管较肝内胆管扩张明显,肝内胆管呈“枯树枝状”;恶性梗阻25例,MRCP主要表现为胆管截断,胆胰管扩张,出现“双管征”,肝内外胆管扩张一致。恶性梗阻患者的肝内外胆管扩张程度明显大于良性梗阻者。结论MRCP作为一种无创的影像检查方法,对肝外胆管梗阻性疾病的诊断具有较高准确性,     

MRI联合CT扫描对肝外胆管梗阻的诊断价值

目的探讨MRI联合CT扫描对肝外胆管梗阻的诊断价值。方法选取2012-09—2017-09间在平舆县人民医院接受手术治疗的110例肝外胆管梗阻患者,以术中所见及病理学结果为良恶性病变的鉴别诊断界点,分析术前CT、MRI和MRI联合CT扫描诊断的准确率及总诊断率。结果术中所见及病理学结果显示,110例患者中良性病变42例,其中胆管结石36例,其他6例。恶性病变68例,其中胆管癌29例、壶腹癌16例、胰头癌23例。MRI诊断良性病变的准确率低于CT扫描(P0.05),但诊断恶性病变的准确率及总诊断率均高于CT扫描(P0.05);MRI联合CT扫描诊断肝外胆管梗阻的准确率及总诊断率均高于单一MRI和CT扫描,差异均有统计学意义(P0.05)。结论 MRI与CT扫描在良恶性病变所致肝外胆管梗阻的鉴别中各有优势。MRI联合CT扫描可有效提高诊断准确率及总诊断率,为临床选择治疗方案提供了可靠的影像学依据。     

IgG4相关硬化性胆管炎的CT和磁共振胰胆管成像表现

目的观察IgG4相关硬化性胆管炎(IgG4-SC)的CT和磁共振胰胆管造影(MRCP)影像表现。方法回顾性分析9例IgG4-SC患者的临床及影像资料,观察IgG4-SC初始病变的CT和MRCP特征及随访变化。结果初始病变:6例CT扫描显示肝外胆管胰腺段管壁增厚,其中2例伴有胰上段胆管壁偏心性增厚,增厚的胆管壁呈渐进性强化;7例MRCP检查中,6例显示肝外胆管胰腺段狭窄,1例肝内胆管狭窄和肝外胆管胰腺段狭窄,狭窄近侧的胆管呈中度至重度扩张。随访:5例未接受类固醇治疗以及2例治疗后复发的患者胆管病变均较初始加重。8例随访患者中,无论治疗及时与否,或是病变复发后再治疗,应用类固醇后胆管病变均显著好转。结论 IgG4-SC的CT和MRCP表现为胆管壁增厚、管腔狭窄和近侧胆管扩张,类固醇治疗后病变明显好转。     

肝门部胆管梗阻的病因分析—附80例报告

目的和方法：复习１９９１年９月至１９９６年的５年病历资料，将其中８０例手术证实、以肝门部胆管梗阻为主要临床表现的病历进行了分析。结果：８０例病人中，恶性梗阻５７例，占６３．８％；良性梗阻２９例，占３６．２％。恶性梗阻主要包括肝门部胆管癌、胆囊癌、肝癌、肝门部转移癌，以肝门部胆管癌常见。良性梗阻主要包括Ｍｉｒｉｚｚｉ综合征、肝门部结石及其他。结论：肝门部胆管梗阻临床上主要表现为黄疸、肝内胆管扩张，应     

CT重建技术在胆管内良恶性梗阻诊断中的应用

目的 探讨16层螺旋CT多平面重建（MPR）和曲面重建（CPR）在胆管内良恶性梗阻诊断中的临床应用价值。方法 收集15例胆管内良恶性梗阻病例,行16层螺旋CT平扫及增强,将肝实质期图像采用1.25 mm薄层重建,将数据传至工作站后,先对胆总管行MPR重建,获得胆总管走行最佳图像,然后在MPR图像的基础上行CPR重建,把不在同一个平面上的胆总管显示在同一个平面上,对梗阻部位及性质进行诊断,并与手术、病理对照。结果 15例胆管内良恶性梗阻病例,胆管癌4例,胰头癌4例,胆总管结石5例,胆总管炎性狭窄2例。MPR、CPR定位诊断100%,定性诊断准确率为93.3%,良、恶性梗阻的鉴别诊断准确率为100%。结论 16层螺旋CT MPR和CPR图像后期处理技术,对胆管内良恶性梗阻病变的定位、定性具有很高临床应用价值。     

肝门部胆管梗阻的病因分析——附80例报告

复习1991年9月至1996年9月的5年病历资料,将其中80例手术证实、以肝门部胆管梗阻为主要临床表现的病历进行了分析。结果:80例病人中,恶性梗阻57例,占63.8％;良性梗阻29例,占36.2％。恶性梗阻主要包括肝门部胆管癌、胆囊癌、肝癌、肝门部转移癌,以肝门部胆管癌最为常见。良性梗阻主要包括Mirizzi综合征、肝门部结石及其他。结论:肝门部胆管梗阻临床上主要表现为黄疸、肝内胆管扩张,应引起高度警惕,防止漏诊,但另一方面有些其他疾病也可造成肝门部胆管阻塞,临床上出现与胆管癌的类似病症,易误诊为胆管癌,也应仔细分析,才能得出正确的诊断。     

局限性肝外胆管狭窄的诊治

目的 研究一类具有相拟胆道影像学表现的局限性肝外胆管狭窄的诊断和治疗。方法 对17例具有相似胆道影像学表现的病人进行回顾性分析,其肝外胆管狭窄的胆道成像表现相似,呈瓶颈样环状缩窄,或呈萝卡根样狭窄,长约1-2cm,狭窄近、远端胆管壁平滑。结果 局限性胆管狭窄病变性质多样。本组良性胆道病变9例,恶性病变8例,包括胆管炎性狭窄、损伤、腺瘤样增生、癌肿、慢性胰腺炎、胰腺结核、胰腺癌、胆囊管癌和Mirizzi综合征。术前确诊困难,术前诊断准确性仅为35.3%。结论 手术探查和活检是确定引起狭窄的病变的性质的关键步骤。病史中有波动性黄疸往往提示良性病变。而血清CA19-9明显升高往往提示恶性病变。胆管空肠Roux-en-Y吻合术是治疗良性局限性肝外胆管狭窄的主要术式。恶性局限性肝外胆管狭窄以根治性切除为主。     

肝门的恶变假象

有关肝门胆管狭窄的治疗,由于难于取得病变恶性的组织学证据,故至今仍有争论。许多肝门胆管狭窄病人均按临床和放射学的依据来处理。这样处理可能造成良性狭窄病人接受不适当的治疗。作者报道了8例类似恶性病变的良性肝门胆管狭窄。其中男性5例,女性3例,平均年龄53岁(37～66岁)。4例进行手术探查,术前诊断为胆总管结石1例,肝管汇合部狭窄2例。入院时病人均有黄疸,肝功能试验符合肝外梗阻。1例有明显的腹膜炎体征,生化检查证实有肾衰。均无炎性肠道疾病时的证据。2例有结石。结果:8例做经皮胆管造影(PTC),2例还做了内窥镜逆行胆管造影(ERCP)。均见肝内胆管扩张,但无弥漫性硬化性胆管炎的放射学表现。所有狭窄均诊断为肿瘤病变。7例狭窄分布在肝总管,波及肝管汇合部,另1例狭窄位于肝总管和胆囊管的连接部位。     

经内镜胆管内支架置入术对良恶性胆管梗阻的临床应用

目的探讨经内镜胆管内支架置入术对各种良恶性胆管梗阻的治疗效果。方法95例良恶性胆管梗阻病人先行内镜逆行胰胆管造影（ERCP）检查,确定胆管梗阻病变部位和性质后,再决定使用内镜下塑料胆道支架引流（ERBD）和内镜下金属胆道支架引流（EMBE）。结果95例患者中92例插管成功,成功率96.84%（92/95）。针对良性胆管梗阻行ERBD 28例,主要见于胆总管结石;针对恶性胆管梗阻行ERBD 44例,行EMBE 20例,主要见于胰头癌、胆管癌、壶腹癌、原发性肝癌及肝门、肝内转移压迫胆管,所有病例均在引流后总胆红素及直接胆红素明显下降。结论：经内镜下胆管内支架引流术的应用愈来愈广泛,其操作安全而有效,特别是对各种良恶性病变引起的胆管梗阻起了关键性的治疗作用。     

Adenomyoma of the Common Hepatic Duct Mimicking Bile Duct Cancer: Report of a Case

We report an unusual case of adenomyoma of the common hepatic duct mimicking bile duct cancer. A 50-year-old woman was referred to our hospital for the investigation of general fatigue. Laboratory data showed abnormal liver test results and computed tomography showed a mass lesion in the hepatic hilum and dilatation of the intrahepatic bile ducts. These findings led to a preoperative diagnosis of hilar bile duct carcinoma, and we performed a left lobectomy with resection of the extrahepatic bile duct. Macroscopically, an elevated lesion was found in the common hepatic duct, which was confirmed histologically to be an adenomyoma. Bile duct strictures are rarely caused by benign tumors of the biliary tract, such as adenomyoma. Surgical resection of the bile duct should be considered for all bile duct strictures because it is often difficult to differentiate malignant from benign lesions in this location preoperatively, and malignant cells may be present in the lesion.     

经皮肝穿刺胆管引流术的常见并发症及防治

目的分析经皮肝穿刺胆管引流术（PTCD）的常见并发症,提出防治措施。方法对220例接受PTCD治疗的梗阻性黄疸患者的资料进行回顾性分析。结果 220例患者中,218例为肝外梗阻性黄疸,其中良性梗阻9例,恶性梗阻209例;2例为肝内梗阻性黄疸,其中硬化性胆管炎1例,肝转移瘤肝内胆管广泛受侵1例。穿刺成功率为99.09%,穿刺失败的2例均为肝内梗阻性黄疸。9例患者于PTCD术后24～72h内死亡。PTCD术中出现胆心反射35例,术后出血6例,感染16例,胸膜损伤3例,胆汁性腹膜炎1例,急性肾衰竭1例,引流管脱出14例,胆汁过度分泌1例,急性前壁心肌梗死1例。结论 PTCD的并发症种类较多,一些严重的并发症可导致患者死亡,但通过术前充分准备、术中及术后积极处理,可有效防止多数并发症的发生。     

Hepatolithiasis in the hepatic hilum mimicking hilar cholangiocarcinoma: Report of a case

We report a rare case of hepatolithiasis, which was diagnosed as hilar cholangiocarcinoma and treated with hepatectomy and extrahepatic bile duct resection. A 59-year-old woman presented to a local hospital with liver dysfunction. Diagnostic imaging revealed a biliary stricture at the hepatic hilum and middle bile duct. Hilar cholangiocarcinoma was diagnosed, and she was referred to our hospital for definitive surgical treatment. She underwent left hepatic trisectionectomy, total caudate lobectomy, and extrahepatic bile duct resection. Gross examination of the resected specimen revealed intrahepatic stones firmly adherent to the bile duct wall. Pathological examination revealed no malignant lesions. The epithelium of the bile duct was absent underneath the stone, and the boundary between the stone and bile duct wall was ill defined. To our knowledge, this is the first case report of hepatolithiasis with a biliary stricture caused by peculiar stone formation, mimicking hilar cholangiocarcinoma.     

Morphologic changes of extrahepatic bile ducts during obstruction and subsequent decompression by endoprosthesis.

The morphologic changes of the extrahepatic biliary tract during obstruction and the effects of biliary decompression by means of an endoprosthesis on the bile duct wall were studied by light microscopy and scanning electron microscopy. Common hepatic duct biopsy specimens and bile cultures were obtained during surgery from 30 patients with a distal common bile duct obstruction caused by a tumor. Thirteen patients had obstructed bile ducts of 3 weeks' duration (group A). Seventeen patients had had jaundice for a period of 4 weeks and had subsequently undergone preoperative endoscopic biliary stenting for a period of 4 weeks (group B). Three autopsy specimens from patients without hepatobiliary disease served as controls. The results showed that the initial dilatation and thickening of the obstructed ducts in group A were associated with a mild inflammation, a moderate degree of fibrosis, and local epithelial disintegration. The presence of an endoprosthesis, however (group B), induced severe inflammatory changes with considerable fibrosis and ulcerative lesions, resulting in markedly thickened ducts with lumina approximating the diameter of the stent. Three of 13 (24%) bile cultures in group A were positive and 14 of 17 (82%) in group B were positive.     

IgG4相关腹部疾病的临床及影像学表现

目的 探讨IgG4相关腹部疾病的临床及影像学表现,提高对该病的认识及诊断水平.方法 回顾性分析2012年10月至2021年1月首都医科大学附属北京佑安医院28例IgG4相关腹部疾病的临床及影像学资料.结果 腹部多个器官(2～5个)受累多见,胆管(100.0％)和胰腺(85.7％)最常受累.胆管受累复杂多样,胆总管下段受...     

Clinical and experimental studies on the etiology of congenital biliary dilatation (CBD)--with special reference to relationship between elastic fibers in the wall of the bile duct and type of CBD

The purposes of this study are to clarify the correlation between the morphological differences in congenital biliary dilatation (CBD) and elastic fibers in the wall of the bile duct. Using forty-three patients with CBD and fifty-seven autopsy cases in which history of biliary disease had not demonstrated, histopathological studies have been performed. In addition, experimental models of anomalous choledocho-pancreatico ductal junction were created in twenty-two young sheep and nine neonatal lambs, and the differences in morphological change were studied in two groups. The results are as follows. 1) Elastic fibers were not seen in the wall of the common bile duct of neonate or infant. So it suggests that the ductal wall was extremely weak in this period and increased intraluminal pressure of the biliary system, induced by distal obstruction, caused the cystic dilatation easily. 2) Fusiform dilatation of the extrahepatic bile duct was produced in all experimental models. The reason why cystic dilatation was not caused in these models is that elastic fibers were abundant in just ductal wall of neonatal lambs. From these results, aging factors may play an important role in the formation of CBD.     

Current status of benign biliary disorders in Japan and accuracy rates of preoperative diagnoses: Collective review of 14,654 patients

Data on 14,654 patients preoperatively diagnosed for benign lesions who had undergone surgical treatment during a 2 year period (April 1979 to March 1981) were obtained from 145 institutions. A total of 18,891 biliary disorders were confirmed and classified into 18 groups: stones in the gallbladder, 12,272 patients (83.7 percent of all patients); stones in the extrahepatic bile duct, 3,605 patients (24.6 percent); stones in the intrahepatic bile duct, 570 patients (3.9 percent); acalculous cholecystitis, 463 patients (3.2 percent); idiopathic dilatation of bile ducts, 375 patients (2.6 percent); stenosing papillitis, 274 patients (1.9 percent); benign stricture of bile ducts, 133 patients (0.9 percent); and others. Malignant tumors were found in 243 patients, of whom 132 (54.3 percent) were not expected to have gallbladder cancer. Accuracy rates for preoperative diagnoses in the patients with gallstones of the intrahepatic or extrahepatic bile ducts or the gallbladder, idiopathic dilatation of the bile ducts, benign stricture of the bile ducts, or benign stenosis of the papilla of Vater were higher than 90 percent. However, the falsenegative rates for these six disorders, except gallstones of the gallbladder, were higher than 16 percent. Therefore, despite advances in diagnostic procedures before surgery, intraoperative examinations remain indispensable for determining the most effective approach to surgical repair.