超声诊断胆囊腺肌增生症1例

病人女，30岁，无明显不适，健康体检时发现胆囊壁回声不均。查体：腹平软，肝脾肋下未及，无压痛、反跳痛，Murphy征阴性。实验室相关检查均正常。超声检查示：肝脏大小形态正常，包膜光滑，实质回声均匀，门静脉主干不宽，肝内外胆管不扩张，肝内未见占位病变。胆囊大小尚可，胆囊体部壁不均匀增厚，最厚处达0．4cm，累及长度2．2cm，其内可见多发小液性囊腔(使用高频探头探查显示更为清晰)，胆囊底部及颈部壁未见异常，腔内未见明显异常回声，脂餐试验示病变处胆囊壁收缩功能亢进。超声诊断：胆囊壁体部异常所见，符合胆囊腺肌增生症声像图改变。病人要求手术治疗而行胆囊切除术。病理检查：胆囊腺肌样增生。     

B型超声诊断胆囊蛔虫症

应用B型超声显象法可使胆管及胆囊蛔虫成象。本文报告一例B超诊断胆囊蛔虫症及超声跟踪结果。患者崔××,女,32岁,工人,病案号10089,因间断性上腹疼一周、加重三天入院,临床拟诊“胆道蛔虫症”。既往有呕吐蛔虫史。我们使用的仪器为Aloka-256型超声显象仪线阵实时扫描,三次超声检查结果如下: 1986年4月11日胆囊大小正常,壁厚0.5cm,胆囊内可见2条平行的强回声细带,中为无回声暗带,可见其蛔虫形态不断变化、扭曲。     

三种影像学检查对华支睾吸虫所致胆胰疾病诊断的对比研究

目的探讨内镜下逆行胰胆管造影（ERCP）与B超和计算机断层成像（Cr）对华支睾吸虫感染所致胆胰疾病的诊断价值。方法将65例粪便中找到华支睾吸虫卵或胆汁中找到华支睾吸虫成虫或虫卵的梗阻性黄疸患者作为研究对象，对其B超、Cr和ERCP检查结果进行对比研究。结果B超最为简单、方便，主要表现为肝内胆管均匀扩张和肝内胆管壁增厚，回声增强并呈等号状为特征。Cr表现为近肝包膜处有均匀扩张的胆管，呈囊状扩张、胆管壁增厚。十二指肠镜下见约32．3％（21／65）的患者表现为乳头形态异常，开口尖细，黏膜外翻，内陷及僵硬感，插管困难。ERCP胆道造影表现为细丝形或椭圆形充盈缺损，末稍胆管呈囊状扩张是最有特征性的表现。合并症以胆管结石最多占40％（26／65），胆管癌及十二指肠乳头癌占9．8％（6／65），胰腺炎占1．5％（1／65）。结论对华支睾吸虫感染所致的胆道疾病，三种检查方法的共同特征为弥漫性肝内胆管末端囊性扩张，ERCP优于体表超声和CT。内镜下十二指肠乳头括约肌切开术和（或）内镜下鼻胆管引流术结合术后驱虫是该病的首选治疗方法。     

自身免疫性肝炎超声表现分析

目的总结分析自身免疫性肝炎患者的超声表现,并探讨原因。方法收集2000年1月-2008年5月天津医科大学总医院确诊的51例自身免疫性肝炎患者的超声诊断并进行回顾性分析。结果自身免疫性肝炎患者的异常超声表现有(1)肝脏:质地不均、密度减低、肝脏缩小、被膜不光滑等;(2)胆囊:胆囊壁增厚、胆囊窝水肿、胆囊强回声团等;(3)脾脏:脾脏增大、脾静脉扩张;(4)腹腔多发淋巴结;(5)腹腔积液等。结论自身免疫性肝炎患者的超声表现为肝脏、胆囊、脾脏、淋巴结等异常,其中腹腔淋巴结增大在自身免疫性肝炎患者中表现较多。     

术后并发胆管狭窄46例临床分析

目的探讨术后并发胆管狭窄的原因及手术治疗方法。方法回顾性分析46例术后并发胆管狭窄患者的临床资料。结果本组胆管狭窄发生于开腹胆囊切除术24例、腹腔镜胆囊切除术10例,胆囊切除＋胆总管探查术8例,肝破裂修补术后4例。根据Bismuth狭窄分类I型21例,Ⅱ型15例,Ⅲ型9例,Ⅳ型1例。本组均行狭窄胆管修复治疗,其中行肝胆管空肠吻合25例,狭窄段胆管或吻合口整形13例,胆总管空肠吻合6例,胆管对端吻合2例。术后并发切口感染9例,腹内感染2例,肠瘘1例。术后随访平均56个月,疗效为优31例,良9例,差4例,死亡2例。结论胆囊切除术是造成术后损伤性胆管狭窄的主要原因,肝胆管空肠吻合术胆管空肠吻合术是主要治疗方法。     

常规超声和超声造影检查诊断肝内胆管细胞癌

目的 探讨肝内胆管细胞癌(ICC)常规超声和超声造影(CEUS)表现.方法 本组纳入52例ICC患者,常规行超声和CEUS检查,组织病理学诊断.结果 灰阶超声表现为均匀低回声者23例(44.2％,不均匀低回声者22例(42.3％),稍高和高回声者7例(13.5％);彩色多普勒血流(CDFI)表现为0级11例(21.2％...     

肝血吸虫病误诊1例报告

患者女 ,2 3岁 ,体检时 B超发现胆囊明显增大 (14.0 cm×6 .0 cm)而就诊。 B超显示胆囊内透声好 ,壁厚约 0 .3cm,肝大小正常 ,肝内回声均质 ,肝内外管道无扩张 ,脂餐后胆囊面积大小无变化。体检 :皮肤巩膜无黄染 ,胆囊区无叩痛。给予消炎利胆治疗。 3个月后 B超复查 ,肝内回声增强 ,略粗 ,胆囊又有增大 (15 .5 cm× 6 .7cm) ,胆囊未见沉积物和点闪烁。肝内胆管轻度扩张 ,左外叶胆管内径达 0 .6 cm,胆总管内径达 0 .72 cm.胆总管内中 ,下段交界处可见 1.2 3cm× 0 .6 cm的实质性略强回声片状区 ,后方无声影。体检 :巩膜 ,皮肤仍无黄染。血…     

超声实时引导下经皮经肝胆管或胆囊穿刺置管引流术治疗急性梗阻性胆管炎在基层医院的应用

目的探讨在基层医院应用超声实时引导下经皮经肝胆管或胆囊穿刺置管引流术(PTCD)初始治疗急性梗阻性胆管炎患者的临床价值。方法回顾性分析2012年2月-2018年6月在腾冲市人民医院实施超声实时引导下PTCD的38例急性梗阻性胆管炎患者的临床资料,其中4例为恶性胆管梗阻并发胆管炎,34例为肝胆管结石导致急性梗阻性化脓性胆管炎。结果穿刺肝右叶胆管30例,穿刺左叶胆管6例,穿刺胆囊2例。首次进针穿刺成功率为92. 1%(35/38),穿刺成功率100%,无出血及胆汁性腹膜炎、胆管血管瘘等并发症,术后2周89. 5%(34/38)的患者TBil下降≥1/2,32例(84. 2%)患者ALT降至正常范围。34例肝胆管结石患者,感染控制后行胆道探查术取石、肝叶切除术等二期手术,或带管转上级医院进一步治疗; 4例肿瘤性胆管梗阻患者带管转上级医院,3例行根治性手术,1例经原穿刺窦道留置胆管支架。结论超声实时引导下PTCD可作为基层医院针对急性梗阻性胆管炎初始治疗的一种有效、简便、安全的减黄技术,其穿刺成功率高﹑对设备要求较低,建议规范技术流程后在基层医院推广应用。     

经皮微波治疗肝癌坏死范围的超声判断

目的探讨在超声引导下经皮微波凝固（PMCT）术治疗肝癌过程中采用实时灰阶超声判断凝固坏死范围的价值。方法在PMCT术治疗19例HCC患者过程中,采用灰阶超声全程监测治疗灶强回声范围的最大短轴径（SDT）和最大长轴径（LDn在治疗后1小时和1个月后,再次行实时灰阶谐波超声造影测量凝固坏死灶对应的SDc和LDc。结果在18例治疗灶明显增强的患者,治疗时病灶表现出椭圆状强回声,其SDT与1小时后超声造影的SDC1的相关系数为0．64,LDT与LDCI的相关系数为0．73;SDT与一月后超声造影SDC2的相关系数为0．79;LDT与LDC2的相关系数为0．76。1例患者术中治疗灶强回声范围表现不明显,超声造影证实为完全坏死。结论在PMCT术中灰阶超声监测的病灶最大强回声范围与术后超声造影所测凝固坏死灶大小具有一定的相关性,可作为治疗时凝固坏死范围的参考;但因它们的相关系数并不高,且有个别病灶强回声表现不明显,故在PMCT术后还应采用多种监测手段综合判断其疗效。     

二维超声心动图诊断心脏囊虫病价值的探讨

应用二维超声心动图检查出３９例心脏囊虫病。对病程短抗囊治疗前的患者超声检查，心脏囊虫病多表现为囊性液性暗区，仔细探查其内可见到强回声光点（囊虫头节），此为诊断心脏囊虫病的特征性表现。对病程长且经过多疗程治疗后的患者，多表现为强回声光点反射，这是囊虫钙化的表现。结果显示，囊虫可在心脏多部位寄生。心脏症状、心电图异常与囊虫在心脏寄生有关。３９例中有心脏症状者３５例（８９．７％）；有心电图异常者２４例（     

Excretion of metroindazole in human bile. Investigations of hepatic bile, common duct bile, and gallbladder bile

Excretion of metronidazole (MNZ) in the normal and in the diseased biliary tract was investigated in 58 patients after oral or intravenous administration of MNZ. After oral administration MNZ appeared rapidly in hepatic bile, and throughout the period of absorption and elimination almost identical concentrations of MNZ were found in serum and hepatic bile. After intravenous administration no significant differences were found between concentrations of MNZ in common duct bile and serum in the non-obstructed common duct; in common duct obstruction, concentrations of MNZ in common duct bile were 56--99 per cent of corresponding concentrations in serum. MNZ was concentrated in normal gallbladders. In patients with gallbladder stones and preserved function of the gallbladder and in patients with no function of the gallbladder but a patent cystic duct, no significant differences were found between concentrations of MNZ in gallbladder bile, common duct bile, and serum. In most gallbladders with the cystic duct blocked by a stone, no MNZ was found in gallbladder bile.     

Endoscopic cholangiopancreatography in hepatic clonorchiasis--a follow-up study

Cholangiographic changes of the biliary system in 16 patients with proven hepatic clonorchiasis, diagnosed by positive stool or bile ova isolates, were studied. All patients presented with epigastric pain. Other symptoms included jaundice in 31% (5 of 16) and fever in 12.5% (2 of 16). Praziquantel given at 25 mg/kg for three doses in 1 day were administered. Three consecutive stool tests were performed 3 months after treatment and were negative in 87.5% (14 of 16). ERCP studies were repeated at a mean interval of 31.6 months (range, 8 to 69 months). Measurements of the bile ducts on retrograde cholangiograms before and after treatment were compared using the paired Student's t test. Filling defects and blunting of the terminal bile ducts seen on the initial cholangiogram, interpreted as the presence of adult worms, disappeared after treatment. However, there was no significant change between pre- and post-treatment measurement of bile duct caliber. Bile duct dilation, irregularities, and ductal proliferation persisted despite eradication of the parasite.     

Clonorchis-associated cholangiocarcinoma: a report of two cases with unusual manifestations.

Two cases of Clonorchis-associated cholangiocarcinoma are described along with their cholangiographic features to illustrate the spectrum of pathology ascribed to the injurious effects of the flukes on the bile duct epithelium. This includes adenomatous hyperplasia, extensive fibrosis, and carcinoma. The first case was also complicated by hepatic abscesses, left hepatic lobar atrophy, gastrobiliary and biliarocutaneous fistulae. The second case features an unusually dilated pancreatic duct containing pancreaticoliths that was found later to consist of hyperplastic bile duct epithelium, presumably carried by worm migration in the biliary tree. Liver sections from both patients showed typical features of hepatic clonorchiasis with the cancer. A knowledge of the wide spectrum of clinical presentation of clonorchiasis, particularly cholangiocarcinoma, might aid Western physicians in averting this serious sequela through prompt eradication of the helminthic infection and early recognition and treatment of its complications.     

The ultrasound survey of gallstone diseases of patients infected with Clonorchis sinensis in southern Taiwan

Ultrasonography was used to evaluate the relationship between the gallstone diseases and infection with Clonorchis sinensis. One thousand and ninety-one Hakkanese in southern Taiwan were examined in the past 2 years. Among the 947 cases infected with clonorchiasis, 89 cases were found to have gallstone diseases, which included gallbladder stones (85 cases), common bile duct stones (three cases) and one case of intrahepatic duct stone, indicating a prevalence of 8.97, 0.32 and 0.11% respectively. The overall prevalence of gallstones in the infected group was 9.39%. In the other 144 cases without clonorchiasis infection, eight patients were found to have gallstone disease, which included gallbladder stone (six cases) and intrahepatic duct stone (two cases), indicating an incidence of gallstone of 4.16 and 1.39% respectively. The overall prevalence of gallstones in the non-infected group was 5.56%. A comparison between the infected and non-infected groups was made and showed no significant relationship between gallstone disease and clonorchiasis.     

An extrahepatic bile duct metastasis from a gallbladder cancer mimicking Mirizzi's syndrome

We report a case of an extrahepatic bile duct metastasis from a gallbladder cancer that mimicked Mirizzi's syndrome on cholangiography. A 67-yr-old woman was admitted to our hospital with a diagnosis of acute calculous cholecystitis. As obstructive jaundice developed after the admission, percutaneous transhepatic biliary drainage was performed to ameliorate the jaundice and to evaluate the biliary system. Tube cholangiography revealed bile duct obstruction at the hepatic hilus, and extrinsic compression of the lateral aspect of the common hepatic duct, with nonvisualization of the gallbladder. No impacted cystic duct stone was visualized on CT or ultrasonography. Laparotomy revealed a gallbladder tumor as well as an extrahepatic bile duct tumor. We diagnosed that the latter was a metastasis from the gallbladder cancer, based on the histopathological features. This case is unique in that the extrahepatic bile duct metastasis obstructed both the common hepatic duct and the cystic duct, giving the appearance of Mirizzi's syndrome on cholangiography. Metastatic bile duct tumors that mimic Mirizzi's syndrome have not been previously reported. The presence of this condition should be suspected in patients with the cholangiographic features of Mirizzi's syndrome, when the CT or ultrasonographic findings fail to demonstrate an impacted cystic duct stone.     

Outcome of gallbladder preservation in surgical management of primary bile duct stones

AIM: To evaluate the methods and outcome of gallbladder preservation in surgical treatment of primary bile duct stones. METHODS: Thirty-five patients with primary bile duct stones and intact gallbladders received stone extraction by two operative approaches, 23 done through the intrahepatic duct stump (RBD-IDS, the RBD-IDS group) after partial hepatectomy and 12 through the hepatic parenchyma by retrograde puncture (RBD-RP, the RBD-RP group). The gallbladders were preserved and the common bile duct (CBD) incisions were primarily closed. The patients were examined postoperatively by direct cholangiography and followed up by ultrasonography once every six months. RESULTS: In the RBD-IDS group, residual bile duct stones were found in three patients, which were cleared by a combination of fibrocholedochoscopic extraction and lithotripsy through the drainage tracts. The tubes were removed on postoperative day 22 (range: 16-42 days). In the RBD-RP group, one patient developed hemobilia and was cured by conservative therapy. The tubes were removed on postoperative day 8 (range: 7-11 days). Postoperative cholangiography showed that all the gallbladders were well opacified, contractile and smooth. During 54 (range: 6-120 months) months of follow-up, six patients had mildly thickened cholecystic walls without related symptoms and further changes, two underwent laparotomies because of adhesive intestinal obstruction and gastric cancer respectively, three died of cardiopulmonary diseases. No stones were found in all the preserved gallbladders. CONCLUSION: The intact gallbladders preserved after surgical extraction of primary bile duct stones will not develop gallstones. Retrograde biliary drainage is an optimal approach for gallbladder preservation.     

家猫检获大量华支睾吸虫1例

华支睾吸虫成虫常寄生于人体肝胆管内,也寄生于狗、猫等动物的肝、胆囊及胆管,可引起华支睾吸虫病——一 种重要的人兽共患寄生虫病。本研究通过解剖1例家猫,从其肝脏和胆囊中检获虫体共736条,经鉴定为华支睾吸虫。 这一发现提示芜湖地区有动物华支睾吸虫病流行,应重视宠物寄生虫感染的防治。     

Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract.

Twenty-four patients with advanced carcinoma of the gallbladder and/or the bile duct underwent hepatopancreatoduodenectomy, that is, en bloc hepatic resection with pancreatoduodenectomy. They included 14 cases of gallbladder carcinoma, nine cases of bile duct carcinoma, and one case of double cancer of the gallbladder and the bile duct. Eleven kinds of hepatic lobectomy or segmentectomy with pancreatoduodenectomy were carried out, and the caudate lobe was also removed en bloc from 17 patients with carcinoma involving the hepatic hilus. Combined resection of the portal vein was performed in 11 patients, of the inferior vena cava in 2, and of the colon in 5, patients. Forty-four postoperative complications occurred in 22 patients (91.7%). The operative mortality rate was 12.5% (3/24). The median survival and the 2-year survival rate were 7.0 months and 17.9% for all 24 patients, including 3 operative deaths, or 11.0 months and 20.4% for 21 patients surviving hepatopancreatoduodenectomy, and 12.4 months and 20.8% for all 14 patients with gallbladder carcinoma, and 5.2 months and 14.8% for all 9 patients with bile duct carcinoma. The longest survivor died of recurrent tumors at 5 years and 7 months. Hepatopancreatoduodenectomy offered not only an unexpectedly long survival period, but also unexpected morbidity in some cases.     

Risk factor for extrahepatic bile duct cancer in patients with anomalous pancreaticobiliary ductal union

BACKGROUND/AIMS: Anomalous connection between the choledochus and pancreatic duct is considered to be a factor in the development of biliary tract diseases such as choledochal cyst, pancreatitis, cholangitis, gallbladder cancer, and bile duct cancer. Our purpose was analysis of combined disease, especially biliary neoplasm and evaluated microscopic changes of extrahepatic bile ducts. METHODOLOGY: To study the clinical characteristics of anomalous pancreaticobiliary ductal union (APBDU), we reviewed 14 APBDU cases from June 1994 to June 1998. We studied the associated disease, surgical treatment, and the histological findings of the extrahepatic bile ducts. RESULTS: Gallbladder cancer was identified in 5 out of 14 patients with APBDU. The incidences of metaplasia of gallbladder and bile duct with APBDU were higher than that of control gallbladder epithelium. The proliferating cell nuclear antigen-labeling index of the gallbladder in patients with APBDU was significantly higher than that in the control group. CONCLUSIONS: The patients with APBDU showed high incidence of gallbladder carcinoma and metaplasia in epithelium of gallbladder and bile duct. As this metaplasia in the gallbladder and bile duct is thought of as a precancerous condition, it is important to remove the place that causes bile stasis and to stop backflow of pancreatic juice into the bile duct in managing patients with this anomaly. In other words, prophylactic cholecystectomy and reconstruction of the biliary tract are both necessary.     

An alternative surgical approach to a difficult case of Mirizzi syndrome： A case report and review of the literature

INTRODUCTION Mirizzi syndrome (MS) is a rare complication of long- standing cholelithiasis, which results from impaction of a large calculus or multiple small stones in the cystic duct or in the neck of the gallbladder causing extrinsic narrowing of the c…