实时超声诊断小儿先天性胆总管囊肿32例

目的总结实时超声诊断小儿先天性胆总管囊肿的经验。方法对32例患者行实时超声检查。结果超声诊断正确者31例,符合率为96.9%。结论实时超声检查是诊断先天性胆总管囊肿的一种简单有效的方法。     

胆总管病变的超声诊断分析

目的　探讨超声对胆总管病变的诊断价值。方法　对62例胆总管病变的超声诊断与手术病理结果进行对照分析。结果　胆总管结石36例，胆总管上段至肝门部肿瘤5例，胆总管囊肿1例，均经手术及病理检查证实。胆总管蛔虫20例。结论　超声是诊断胆总管病变的首选检查方法，能直接观察胆总管病变情况，但对胆总管泥沙结石及胆总管肿瘤的区别要综合多因素共同分析，以求更准确的诊断。     

先天性胆总管囊肿的产前超声诊断

目的 探讨产前超声在先天性胆总管囊肿诊断中的应用价值并分析其声像图特点.方法 回顾性分析2009~2015年在安徽省妇幼保健院超声科诊断为先天性胆总管囊肿患者6例,总结其超声声像图特点,并与MRI检查及出生后超声、手术病理进行对比,分析产前超声诊断的准确性.结果 6例产前超声诊断为胎儿先天性胆总管囊肿的病例,均经胎儿MRI检查证实,所有孕妇均选择保留胎儿,其中5例足月分娩,1例于35周早产,6例患儿于出生后6个月内行胆总管囊肿手术,病理结果均为先天性胆总管囊肿.产前超声声像图特点:①腹腔囊性包块;②囊性肿块回声与胃泡不相通,可与胆囊或肝内胆管相通;③可伴有肝内胆管扩张;④肿块内部无血流信号显示,肿块周边见肝动脉样血流信号.结论 先天性胆总管囊肿具有典型的声像图改变,产前超声能明确诊断.     

实时超声显象诊断小儿先天性胆总管囊肿

本文报告31例小儿先天性胆总管囊肿的实时超声诊断结果,经与手术结果对比,超声诊断正确者30例,符合率达96.8%.另1例超声显示肝外胆管呈梭形扩张,而未能明确提出胆总管囊肿,占3.2%.     

A型和B型超声诊断先天性胆总管囊肿(附19例报告)

先天性胆总管囊肿又称先天性胆总管囊性扩张,是一种多见于小儿的先天性胆道畸形。近年来随着诊断技术的进步,检出率日益增高。超声检查对本病的诊断意义较大,尤其应用实时超声显像仪诊断先天性胆总管囊肿(以下简称胆总管囊肿)以来,显著提高了诊断符合率。本文报告19例经手术证实为胆总管囊肿者,以探讨 A 型和 B 型超声对本病的诊断与鉴别诊断价值。     

肝包虫囊肿破入胆总管的超声诊断分析

目的 研究了13例肝包虫囊肿破入胆总管的超声影像学特征,旨在提高对本病的声像图的特征认识.方法 回顾分析我院住院并经手术证实的13例肝包虫囊肿破入胆总管患者的超声图像资料.结果 13例肝包虫囊肿破入胆总管的声像图特征为：肝内可见破裂无张力感的包虫囊肿;肝内外胆管扩张;胆管内的长条、双线状高回声带;诊断符合率达100％.结论 超声诊断该病有较高的特异性,是诊断肝包虫囊肿破入胆道的首选检查方法.     

12例肝包虫囊肿破入胆总管超声诊断

目的：研究了12例肝包虫囊肿破入胆总管声像图,旨在提高对本病声像图特征认识;方法：分析了12例肝包虫囊肿破入胆总管的声像图资料,并经手术证实,结果：12例肝包虫囊肿破入胆总管声像图特征为囊性占位病变,胆总管扩张及胆总管、胆囊内不均质回声,诊断符合率达100%,结论：超声诊断该病有较高特异性,是检查诊断本病的首选方法。     

超声显像在小儿急腹症诊断中的应用

目的探讨超声显像在小儿急腹症中的诊断应用价值。方法回顾性分析117例小儿急腹症病人超声资料。采用HP5500型彩色超声诊断仪及美国百胜Au3超声诊断仪，做腹部纵、横切面及多切面超声检查。结果117例病例中，肠套叠45例，阑尾炎30例，先天性胆总管囊肿21例，肠梗阻21例。结论超声显像对小儿急腹症的诊断具有一定的特异性和敏感性。     

胆总管下段软组织病变的超声诊断

目的　探讨胆总管下段软组织病变的超声检查及其临床意义。　方法　对 87例胆总管下段软组织病变的超声诊断结果与手术病理或随访结果进行对照。　结果　超声检查怀疑胆总管癌 16例 ,术后病理诊断为胆总管癌 12例 ,壶腹癌 4例。超声检查怀疑壶腹癌 18例 ,术后病理诊断为壶腹癌 15例 ,胆总管癌 2例 ,软组织炎症 1例。超声检查拟诊为胰头癌 4 0例 ,均与术后病理诊断结论相符。超声检查怀疑十二指肠乳头癌 7例 ,术后病理诊断为十二指肠乳头癌 5例 ,壶腹癌 2例。胆总管癌合并胆总管下段结石 4例 ,其中 3例超声检查胆总管癌漏诊。2例超声诊断无法确定病变性质 ,随访结果为软组织炎症。超声诊断结果与病理诊断或临床随访结果相符率为 83.9%(73/87)。　结论　超声检查对胆总管下段软组织病变与胆总管结石容易鉴别 ,对软组织病变的良恶性病变鉴别有困难 ,必要时应结合十二指肠镜或 ERCP检查     

彩色多普勒超声诊断成人先天性胆总管囊性扩张症的价值

目的 通过对先天性胆总管囊性扩张症的诊断分析,总结其声像图特点,提高对其的诊断和鉴别诊断能力. 方法 25例先天性胆总管囊性扩张症患者行彩色多普勒超声检查. 结果 囊肿位于胆总管全程的16例、肝内胆管2例、胆总管下段7例,位置最下可达胰头后下方;其中6例在无回声区内见多个大小不等的强回声团,后伴声影,随体位变化而移动;脂餐后见胆囊和囊性肿块均有一定程度的缩小. 结论 在临床上如遇有"三联症",同时在腹部超声检查发现有较大的囊性占位病变的患者时,应要考虑为本病,囊肿与胆总管或胆管相通并呈漏斗型是诊断本病的重要证据,同时要注意与肝囊肿和胰头囊肿相鉴别,必要时行脂餐试验予以鉴别.     

肝胆管囊腺癌的超声诊断

目的总结肝胆管囊腺癌的二维及彩色多普勒超声表现,探讨其对本病的诊断价值。方法对我院13例经手术病理证实为肝胆管囊腺癌的病例进行回顾性分析。结果超声确诊2例,误诊11例。超声检查特点为以液性囊腔为主伴有实性组织回声,囊壁不规则增厚,可见乳头状物或不规则组织突起,内可见分隔;也可表现为以胆管扩张为主,内见絮状回声。CDFI显示囊壁及分隔可探及血流信号。结论超声检查能够显示肝胆管囊腺癌的特征性表现,可作为诊断肝胆管囊腺癌的重要检查方法。     

Congenital choledochal cysts in adults: twenty-five-year experience

Background Choledochal cyst is rare in western countries. The relatively high incidence of coexistent hepatobiliary disease increases the difficulty of the surgical management of choledochal cyst. Here we analyze the diagnosis and treatment of congenital bile duct cyst in 122 Chinese adults. Methods The clinical data of 122 patients with congenital choledochal cysts admitted from 1981 to 2006 were analyzed. Results Clinical symptoms in most cases were nonspecific, resulting in delayed diagnosis. Sixty-one patients (50%) had coexistent pancreatobiliary disease. Among the 122 patients, 119 patients underwent ultrasonic examination; ERCP/MRCP was performed in 63 cases and CT in 102 cases. Abnormal pancreatobiliary duct junction was found in 48 patients. Sixteen patients had malignant lesions in the bile duct, arising in 11 of them from incomplete choledochal cyst that underwent various operations including cystenterostomy or cystojejunostomy. There was significant difference between the patients who underwent incomplete cyst resection and complete cyst resection in malignancy rate of bile duct (Chi square test, P= 0.000; odds ratio, 7.800; 95 % confidence interval, 2.450 to 24.836). Conclusions ERCP, CT and MRCP had proved their great values in the classification of the disease. Cyst excision with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice for patients with type I or type IV cysts. For type V cyst (Caroli’s disease) with recurrent cholangitis, liver transplantation should be considered.     

原发性先天性胆管囊肿癌变7例的诊断与治疗

目的：总结20年来7例在发性胆管囊肿癌变的诊断及治疗经验。方法：对1980－2000年间收治的7例原发性胆管囊肿癌变病人的临床资料进行回顾性分析。结果与结论 癌变6例位于囊壁,1例侵及胰腺,术后病理结果为腺癌。对先天性胆管囊肿病人推荐行新的预防癌变的手术方式,术中冰冻切片检查有助于确诊,对侵及胰腺的病例考试行囊肿切除及胰十二指肠切除术。     

苗勒氏管囊肿蒂扭转并发膀胱癌1例

回顾分析江苏省中医院收治的1例苗勒氏管囊肿蒂扭转并发膀胱癌患者的诊治过程，患者在全麻下行“经腹右侧附件切除+盆腔粘连松解+膀胱镜检术 ”，术后病理诊断为苗勒氏管源性囊肿、(膀胱)乳头状尿路上皮癌，低级别。术后予进一步化疗，后期随访患者各项指标均正常，未诉明显不适。B超、CT及MRI均可发现苗勒氏管囊性包块，确诊需依据组织病理学检查，囊肿多为良性，手术切除安全有效。     

ERCP对成人先天性胆管囊肿的诊断及治疗价值

目的:评价经内镜逆行胰胆管造影(ERCP)对成人先天性胆管囊肿诊断和治疗的价值。方法:ERCP检查24例成人先天性胆管囊肿,并对其中11例合并梗阻性黄疸和化脓性胆管炎的病人及时行内镜下鼻胆引流术(ENBD)治疗。结果:按Todani的分类标准,ERCP检查发现Ⅰ型胆管囊肿14例(58.3%)、Ⅳa型8例(33.3%)、Ⅴ型即Caroli’s病2例(8.3%),其中包括囊肿癌变3例,胰胆管合流异常(APBDJ)4例。ERCP对胆管狭窄范围的判断及APBDJ的诊断优于CT及B超。ERCP治疗10例,包括胆管结石4例,胆管狭窄2例,胆管炎2例,囊肿癌变2例。ERCP治疗后1周内病人血白细胞计数、总胆红素、丙氨酸氨基转移酶、碱性磷酸酶明显下降。结论:成人先天性胆管囊肿Ⅰ型最为常见,胆管囊肿癌变率高、易合并相关的肝胆系统疾病。ERCP对胆管囊肿及APBDJ的诊断和分类较B超和常规CT检查更为直观、准确。ENBD治疗可迅速缓解梗阻性黄疸和化脓性胆管炎病人的症状,为进一步手术治疗创造良好的条件。     

先天性胆管囊性扩张症的术式选择

目的探讨先天性胆管囊性扩张症外科治疗方法。方法回顾分析我院10年间诊治的先天性胆管囊性扩张症48例的诊断、手术方式和疗效。结果①根据患者的症状及其检查,早期诊断及治疗是治愈的关键。②先天性胆管囊性扩张症的手术方式包括囊肿引流术,囊肿空肠Roux—en—Y吻合术和囊肿切除肝管空肠Roux—en—Y吻合术。③全部病例随访结果提示,行肝管空肠Roux—en—Y吻合术的患者术后并发症少,生活质量高。结论合理的外科治疗方法选择对治疗先天性胆管囊性扩张症有重要意义,肝管空肠Roux—en—Y吻合术是较为理想的手术方法。     

Diagnosis and management of hepatic hydatidosis complicated with biliary fistula.

A total of 1,204 patients with liver hydatidosis were treated by operations in our hospital from 1953 to 1990. Of these 74 had biliary fistulae. Growth of echinococcus cyst causes displacement, distortion and stenosis of the hepatic ductules with impaired bile drainage. Biliary effusion may occur between the endo- and ecto-cyst walls. Long term compression renders the hepatic ductule atrophic, and liable to rupture, forming a hydatid cyst-biliary fistula. The hydatid cyst can rupture into the biliary tract, and cyst fluid escapes into the biliary tract with daughter cysts discharged into the common bile duct, causing biliary colic, obstructive jaundice and possibly liver abscess. For acute obstructive and suppurative cholangitis, drainage of purulent bile and daughter cysts and management of the infected hydatid cyst are indicated. After removal of the echinococcus cyst, the fistulous opening on the hepatic duct must be sutured, but a small biliary fistula may be left alone. According to the thickness of the ectocyst wall, size of the cavity, severity of the infection, and degree of bile leakage, one of the following operative procedures for obliteration of the residual cavity can be selected: (1) closure by inversion suture of ectocyst; (2) omental or muscle flap obliteration; (3) closed catheter drainage.

     

超声内镜对胰胆疾病的诊断价值

目的：探讨超声内镜（ＥＵＳ）对胰胆疾病的诊断价值。方法；对３０例慢性胰腺炎，５０例胰腺癌，１４例十二指肠壶腹癌，９例胆总管癌，３０例胆管结石，８例先天性胆总管囊肿及２例胆总管蛔虫进行ＥＵＳ检查，并与腹部超声（ＵＳ）、ＣＴ及ＥＲＣＰ检查结果进行比较。