经皮肝穿刺胆道造影诊断胰胆管合流异常的价值

目的 探讨经皮肝穿刺胆道造影(PTC)诊断胰胆管合流异常(PBM)的临床价值及可行性,总结其影像特征.方法 回顾性分析连续的363例因阻塞性黄疸PTC下行介入治疗患者的临床及影像资料,并根据病例入选标准筛选出资料完整、胰管显影的病例.通过影像测量胆胰共同管长度、直径,汇合处胰胆管直径、汇合角度等,并经校正得到实际数值,结合PBM诊断标准进行诊断.采用t检验比较测量值与正常值有无统计学意义,采用独立样本秩和检验分析测量的胆胰共同管长度、汇合角度与十二指肠乳头位置的关系.结果 本组病例根据PTC结果共确诊PBM 38例,检出率为10.5%(38/363);PBM患者共同管长度为(12.6±7.9)mm,明显高于正常的6 mm(t=5.15,P<0.05).汇合处胆总管直径、胰管直径、共同管直径分别为(3.7±1.9)、(2.4±1.3)、(3.3±1.4)mm,与正常值(分别为6、3、2 mm)比较差异无统计学意义(t值分别为1.79、2.85、5.72,P值均>0.05).十二指肠乳头开口于降部中段1/3部位15例,共同管长度为(10.6±9.1)mm,汇合角度51.1°±28.0°;异常开口组:降部下1/3段10例、交界处8例、水平部5例,共同管长度分别为(9.9±3.7)、(18.6±8.9)、(13.9±3.5)mm,汇合角度分别为54.0°±18.6°、48.7°±12.6°、74.4°±18.5°.十二指肠乳头部位不同的患者间,共同管长度差异有统计学意义(X2=14.51,P<0.05),乳头部位距壶腹部越远,共同管越长.结论 PTC诊断PBM安全、可行,并具有一定的特征性.     

PTC对胰胆管合流异常的鉴别诊断

目的 探讨经皮肝穿刺胆道造影(PTC)诊断胰胆管合流异常(PBM)的可行性、影像学表现及其与Oddi括约肌功能异常(SOD)的影像学鉴别诊断.方法 回顾性分析363例阻塞性黄疸患者行PTCD治疗的l临床及影像学资料,确立病例入选标准、PBM诊断参考标准.由2名高年资医师阅片,分析临床资料完整的胰管显影病例,影像学测量其胆胰共同管长度,并经校正得到实际数值,与正常值进行统计学比较.对非PBM型胰管显影者分析,结合临床及现行的SOD临床诊断标准,作出初步诊断.结果 42例胰管显影的病例中,临床初诊PBM 38例,SOD 4例.PTC显示38例PBM患者胆总管、胰管在十二指肠壁外高位汇合,共同管较长,为(12.6±7.9)mm,明显高于正常长度标准6 mm(t=5.15,P<0.05);且十二指肠乳头开口越远,共同管越长.4例SOD中,1例为胆囊切除术后综合征,3例考虑为胰胆管间纵行括约肌缺如.结论 PTC是诊断PBM的可行方法之一,结合临床可初步与SOD影像诊断相鉴别.但诊断PBM首选无创性诊查方法.     

逆行胰胆管造影120例X线分析

本文通过106例逆行胰胆管造影X线所见,并结合45例手术结果对照分析及ERCP与CT、B型超声比较,说明ERCP是诊断胆道结石的重要手段之一,特别是对胆管结石的X线诊断更具有重要价值。同时,对造影中应注意的假象,胆管结石与胆管癌、胆管内血凝块的鉴别诊断、胆囊切除术后的X线阻塞征象、胆囊不显影的原因等也进行了探讨。     

磁共振胰胆管成像诊断胰胆管合流异常的价值

目的 探讨磁共振胰胆管成像（MRCP）诊断胰胆管合流异常（APBDU）的价值。资料与方法 分析11例患者的MRCP、轴面T2WI及T1WI。测量共通管长度和胆总管宽度,观察APBDU的形式,以及胆管内有无结石和肿瘤等相关疾病。将观察结果与B超及内镜逆行性胰胆管造影（ERCP）检查和／或外科手术所见对照。结果 10例胆总管囊肿型APBDU包括胆管囊状扩张7例,梭形扩张3例;1例非囊肿型APBDU表现为胆总管轻度扩张。胆总管最大直径范围是12～90mm,平均34mm。APBDU的合流形式包括A型7例,B型4例,在MRCP图像测量的共通管长度范围是18～30mm,平均23mm。轴面T2WI显示胆总管或胰管突然蝌蚪或逗点样增粗5例。APBDU相关疾病包括胆囊／胆管结石6例,胆管肿瘤1例,胰腺炎5例。对7例切除的病变胆管和胆囊标本进行病理组织学检查,均有慢性炎症改变。结论 MRCP检查有助于发现和诊断APBDU,轴面T2WI和B超检查阴性结果不能完全排除本病。     

胆管非扩张型胰胆管合流异常合并胆道肿瘤二例

胰胆管合流异常（anomalous pancreaticobiliary ductal union，APBDU）指解剖学上胰管和胆管在十二指肠壁外提前汇合的先天性畸形。已知APBDU是多种胆系和胰腺疾病的重要病因之一，特别是胆道肿瘤。现将二例APBDU报告如下。     

儿童胰胆管合流异常的临床特征与影像学诊断价值

目的：分析不同影像学方法在儿童胰胆管合流异常（PBM）的诊断价值,以提高对本病的认识。方法：回顾性分析我院30例经磁共振胰胆管成像（MRCP）及内镜下逆行胰胆管造影术（ERCP）诊断的儿童PBM,分析其临床资料及影像学检查结果并进行分型,探讨各影像学方法在诊断本病中的优势。结果：（1）临床资料：本组30例患儿,男性7例,女性23例,平均年龄4.3岁。（2）首发症状：腹痛24例,皮肤黄染6例,呕吐6例,体检发现1例。（3）实验室检查：血清淀粉酶或脂肪酶升高、肝功能异常共28例,实验室检查无异常2例。（4）影像学结果：本组30例患儿,MRCP明确诊断为PBM者22例（73.3%,22/30）,其中分型为A型11例,B型2例,C型9例,D型0例;ERCP确诊者30例（100%,30/30）,其中分型为A型13例,B型2例,C型14例,D型1例;29例均伴随不同程度的肝（内）外胆管扩张;MRCP提示胆总管中或下段结石12例,ERCP确诊结石共16例并诊断胆总管下段或胰管内蛋白栓17例。（5）随访：30例中19例接受1次ERCP检查,另有10例和1例因反复胰腺炎发作接受2次及3次ERCP检查。结...     

HASTE磁共振胰胆管成像诊断胆道恶性梗阻病变的价值

目的探讨HASTE磁共振胰胆管造影在胆道恶性梗阻病变诊断中的应用价值。方法分析经手术病理或活检证实的43例胆道恶性梗阻病变患者的HASTE-MRCP影像表现。结果HASTE-MRCP诊断胆道恶性梗阻,其定位诊断符合率为100%,定性诊断符合率为75%。结论HASTE-MRCP在胆道恶性梗阻性病变的诊断中具有良好的应用价值。     

恶性胆道梗阻的磁共振胰胆管造影诊断

目的 评价磁共振胰胆管造影（MRCP）对胆道恶性梗阻性疾病的诊断价值。材料与方法 43例恶性胆道梗阻患者（胆管癌15例,壶腹癌4例,胰头癌10例,转移性癌10例,原发性肝癌4例）行MRCP检查,结合PTC、ERCP检查、手术、病理结果、临床资料进行综合分析。结果 43例患者MRCP检查均一次成功,胆管及扩张胰管显示满意,定位诊断准确率为100％、定性准确率为83．7％。肝门区癌肿MRCP表现为肝门区不规则或类圆信号缺损,肝内胆管扩张以肝门区为中心呈“枯枝”状或“蟹足”样扩张;肝外胆管癌胆管断端呈模形或“鸟嘴”样截断;壶腹癌胆管断端呈横形、“鸟嘴”样或“鼠尾”状截断;胰头癌胆管断端呈“鸟嘴”样或“鼠尾”状截断,90％（9／10）伴“双管征”;转移性癌肿MRCP表现与转移部位有关;转移至肝门附近与肝门区癌肿相似,肝外转移者与相应部位胆管癌、胰头癌相似,常规MRI可见明显转移肿块或淋巴结。结论 MRCP是胆道恶性梗塞影像学检查的有效补充手段,可为恶性胆胰肿瘤术前可切除性提供评价,对不可切除的癌肿行介入治疗提供参考。     

胰胆管合流异常的磁共振诊断

正常情况下,胆总管与主胰管在十二指肠壁内汇合,共同通道的长度<0.5 cm(图1);胰胆管合流异常(anomalous junc-tion of the pancreaticobiliary duct,AJPBD)是指胆总管与主胰管在十二指肠壁外汇合的一种先天性解剖异常[1,2](图2),当两者在十二指肠壁外汇合时,汇合处缺乏Oddi′s括约肌,且汇合的角度增大,胰液与胆汁相互返流,胰酶激活,可引起一系列胆胰系统的外科疾病,如先天性胆管扩张症、急慢性胰腺炎、胆管癌、胆囊癌、胆系结石等,晚期尚可引起肝硬化、门静脉高压,因此及时发现、诊断AJPBD具有重要的临床意义。AJPBD在自然人群中的发…     

磁共振胰胆管成像与钆贝葡胺增强胆道成像在3T MR上的比较

目的：对比磁共振胰胆管成像和钆贝葡胺（Gadobenate Dimeglumine）增强胆道成像对肝胆管的显示能力.材料与方法：2006-03～2009-04解放军总医院行活体半肝移植的供体64例,术前在GE SIGNA-EXCITE 3.0T扫描仪上行冠状位厚层单击发快速自旋回波（2D-SSFSE）、3D快速自旋回波容积扫描（3D-FRFSE）及肝特异性造影剂钆贝葡胺增强胆管成像的肝脏快速三维容积采集序列（3D-LAVA）扫描,在GE 4.3图像工作站行MIP后处理重建胆道系统,对比三种方法肝胆管显示能力并与术中所见对照.结果：三种成像方式显示胆总管、胆囊、肝总管、肝内一级胆管效果的差异无显著性意义（P〉0.5）.3D-FRFSE对肝内三级以上胆管显示优于2D-SSFSE和钆贝葡胺造影（P〈0.05）,而肝胆管钆贝葡胺造影在诊断肝胆管解剖变异方面优于2D-SSFSE和3D-FRFSE序列.结论：肝特异性造影剂钆贝葡胺可单独用于肝胆管成像,与常规磁共振胰胆管成像联合应用有利于提高胆道显示的满意度.     

磁共振胰胆管成像在胰胆管疾病中的诊断价值

目的：探讨磁共振胰胆管成像（ＭＲ ｃｈｏｌａｎｇｉｏｇｒａｐｈｙ,ＭＲＣＰ）对胰胆管疾病的诊断价值。材料和方法：用ｆａｓｔ－ＡＳＥ序列完成了８２例ＭＲＣＰ检查,其中有６３例经手术病理证实,余为超声或ＣＴ证实,经二维（２Ｄ）及三维（３Ｄ）处理图像,后以最大信号投影重建图像。结果：全部检查均获得成功。良、恶性胰胆管疾病在ＭＲＣＰ图像上具有一定的特征性。ＭＲＣＰ定位及定性准确率分别为１００％及８６％。结论：ＭＲＣＰ是一种无创伤性的有效手段,能清楚显示正常或异常的胰胆管结构,定性和定位准确率高,能为临床提供十分有意义的诊断资料。     

Percutaneous Transhepatic Use of a Cutting Balloon in the Treatment of a Benign Common Bile Duct Stricture

Benign biliary strictures (BBS) are difficult to treat. The majority of them are treated either endoscopically or using percutaneous techniques either with stents or conventional angioplasty balloons. To our knowledge we present the first case of use of a cutting balloon in the treatment of BBS through a percutaneous approach.     

Primary Malt Lymphoma of the Common Bile Duct

Primary mucosa-associated lymphoid tissue (MALT) lymphoma arising in the common bile duct (CBD) is extremely rare. In our case of MALT lymphoma, CT and MRI showed long, segmental, irregular wall thickening of the CBD and minimal dilatation of the upstream bile duct. A preoperative diagnosis of cholangiocarcinoma was made, but histologic evaluation confirmed MALT lymphoma of the CBD. We herein present a rare case of MALT lymphoma of the CBD with CT and MRI findings.     

Common Bile Duct Stones Detected After Cholecystectomy: Advancement into the Duodenum via the Percutaneous Route

Purpose: To report our experience in the use of percutaneous extraction of common bile duct stones detected in the post-cholecystectomy period. Methods: Forty-two patients in whom endoscopic cannulation and/or sphincterotomy had failed or could not be done due to several reasons underwent balloon dilatation of the ampulla of Vater and subsequent advancement of the stones via the percutaneous transhepatic route or T-tube tract. Results: The procedure was successful in 42 cases. In three patients, stones were crushed in the common bile duct and pushed as fragments into the duodenum. In all cases transient adverse effects were observed. There were no major complications. All cases were checked with ultrasonography for 6 months after the procedure. Conclusion: Percutaneous extraction of common bile duct stones is an effective method of treatment with a high success rate, low complication rate and shorter hospital stay. It may serve as an alternative method in cases where endoscopic removal of stones fails.     

胆囊管残留过长的X线诊断（附33例报告）

本文报告直接法胆系造影发现的３３例胆囊切除术后胆囊管残端过长，均经再手术证实。对胆囊管残留过长的解剖学原因和临床病理表现进行了研究。并就如何避免胆囊管残留过长等问题作了讨论。     

胆囊管低位汇入的X线诊断（附84例报告）

探讨胆囊管低位汇入的Ｘ线表现，着重讨论胆囊管的胚胎学、解剖学、生理学及其临床病理学诸问题，材料和方法：报道８４例直接法胆系造影发现，并经手术病理证实，就胆囊管的长度、宽度和瓣膜的病理改变进行了研究。结果：８４例低位汇入者中胆囊管过长５２例，胆囊管明显扩张５７例，胆囊管瓣膜减少４０例。８４例中慢性胆囊炎７９例，胆囊结石３３例，其他疾病４５例。结论：胆囊管低位汇入为一种先天异常，术前行直接法胆系造影了     

原发性肝外胆管癌的影像学表现：附90例报告

笔者报告了经手术、病理证实的９０例肝外胆管癌的影像学表现。细胞学诊断为腺癌和鳞癌。病变位于肝外胆管上段６７例（７４．４％），中段４例（４．４％），下段１０例（１１．１％）和广泛型９例（１０．０％）。直接胆道造影的特征有阻塞、狭窄和息肉三型。笔者讨论了胆管癌在恶性阻塞性黄疸发病中的地位和影像学对发现胆管癌的作用，并提出Ｂ超、ＰＴＣ为本病的最佳影像学方法。     

Chronic Extrahepatic Bile Duct Dilatation: Sonographic Screening in the Patients with Opioid Addiction

Objective

One of the best known side effects of using opium is spasm of the sphincter of Oddi, which may increase the diameter of the extrahepatic bile ducts. Ultrasound is the first imaging modality used for evaluating the biliary system because it is commonly available and noninvasive. The principal objective of this study was to measure the common bile duct (CBD) diameter via ultrasonography in opium addicts and to evaluate the relation between the CBD diameter and the period of addiction.

Materials and Methods

This research was an analytical-cross sectional study that was done on 110 opium addicts that were admitted to a drug treatment center. The diameter of the CBD in these cases was measured by ultrasonography and the results were analyzed with other factors like age, the period of addiction and the laboratory findings.

Results

According to the findings, there is a significant increase in the range of the CBD diameter in comparison with normal bile ducts. Also, the mean diameter of the CBD in the different age groups showed a significant difference (p < 0.0001) and there was a significant relation between the CBD diameter and the period of addiction (p < 0.001, r = 0.74); so, with the increased length of the addiction period, the mean CBD diameter increases.

Conclusion

Opium addiction is one of the factors that causes extrahepatic bile duct dilatation, so in these cases, if no obstructing lesion was found on ultrasound examination and the serum bilirobine and alkaline phosphatase levels are normal, then further evaluation is not needed.     

Radiologic Evaluation and Structured Reporting Form for Extrahepatic Bile Duct Cancer: 2019 Consensus Recommendations from the Korean Society of Abdominal Radiology

Radiologic imaging is important for evaluating extrahepatic bile duct (EHD) cancers; it is used for staging tumors and evaluating the suitability of surgical resection, as surgery may be contraindicated in some cases regardless of tumor stage. However, the published general recommendations for EHD cancer and recommendations guided by the perspectives of radiologists are limited. The Korean Society of Abdominal Radiology (KSAR) study group for EHD cancer developed key questions and corresponding recommendations for the radiologic evaluation of EHD cancer and organized them into 4 sections: nomenclature and definition, imaging technique, cancer evaluation, and tumor response. A structured reporting form was also developed to allow the progressive accumulation of standardized data, which will facilitate multicenter studies and contribute more evidence for the development of recommendations.