口服法螺旋CT胆管造影临床应用价值探讨

目的探讨口服法螺旋CT胆管造影对胆系疾病的诊断价值和对胆系手术的指导价值。方法可疑胆系病变患者18例。服用碘番酸后12~14h行CT扫描,并行2D、3DMIP重建。据碘番酸剂量分大剂量组(6.0g)5例,中剂量组(3.0g)10例和小剂量组(1.0g)3例。显影程度分未显影、轻度显影、良好显影和过度显影4级。造影结果与病理和/或临床结果对照。结果(1)胆管显影与碘番酸剂量有关。观察肝内胆管用量不应<6.0g,观察肝总管和胆总管3.0g基本满足要求。(2)口服法螺旋CT胆管造影可显示肝内外胆管特别是肝外胆管的解剖结构,反映胆系功能和其通畅情况以及病变与胆管之间的关系,对胆囊阴性结石和胆囊息肉诊断的敏感度为80%,对胆总管阴性结石诊断的敏感度为88.89%,特异度为100%。(3)2D和3DMIP重建空间感好,是原始图像的重要补充。结论口服法螺旋CT胆管造影简便、无创,是显示肝内外胆管解剖结构和诊断胆系病变的一种较好方法,对胆系手术有指导作用。     

胆胰影像学现状与评价

随着MR、CT等新技术的发展及广泛应用,胆胰影像学检查更趋完善和直观。现就其新发展及我们在ERCP基础上新近研究的胆胰双重造影术做一简要综述。1　胆胰影像检查方法70年代以前胆胰系统检查主要依靠腹平片、胃肠造影、口服胆囊造影及静脉胆道造影。其发展缓慢,胆囊及胆道疾病诊断的准确性较低,胰腺疾病还没有直接影像学检查方法。70年代后超声、经皮经肝胆管造影、内窥镜逆行性胆胰管造影、CT、MR相继应用于临床,胆胰疾病诊断的准确性均有所提高。90年代随着螺旋CT、MR等在临床广泛应用,胆胰检查方法得到迅猛发展,近年来出现了无X线…     

CT对判断胆道和胆囊病的价值

本文回顾了胆囊胆道疾病的X 线诊断后指出,CT 对胆系疾病如结石、炎症和肿瘤等诊断颇有价值,在瘀胆、胆系造影显影不良和右上腹疾病原因不明时均值得使用。一、正常与变异:胆囊的位置、形态、大小等变异较大。由于胆     

选择性胆囊切除术前静脉胆管造影代替常规术中胆管造影

作者回顾性分析了用术前静脉胆道造影代替常规术中胆道造影的286例选择性胆囊切除病人。病人均由超声或/和口服胆囊造影证实有胆囊结石,在行选择性胆囊切除术前做静脉胆道造影以检查胆总管内有否结石。作者见到,286例病人中有12例因胆总     

胆囊管引流入右侧肝管一例报告

胆道先天异常对胆道外科手术有一定的临床意义。我们在胆囊造影检查中发现一例胆囊管引流入右侧肝管病例,经手术证实,现报告如下:病史:女,14岁,右侧上腹部疼痛4年余,B超检查报告:慢性胆囊炎并发结石。患者于1986年12月住院,术前其它各项检查均在正常范围。X线检查:静脉胆囊造影:静注50％胆影葡胺20毫升     

静脉胆管造影:时间—密度—滞留概念的实验研究

时间—密度—滞留概念是由Wise 和O’Brien在1956年首先提出的。他们认为在静脉胆管造影时,如果胆总管显影密度在120分钟大于60分钟,则在胆囊切除或胆囊管阻塞的病人就有很大的把握来推断有胆总管部分梗阻。这种观察仅是从大量的临床病例中得到的,尚没有实验证实。本文对不同程度胆总管梗阻和以后引起进行性肝实质病变的慢性胆瘘的狗进行了胆影优和胆影葡胺对比研究。作者通过分别增加胆管内压力20和30厘米水柱获得胆总管部分梗阻。通过给狗口服二甲基亚硝基胺(DMNA)产生肝实质损害。然后分别随机输入胆影优和胆影葡胺并测定二者在胆汁内浓度。     

胆道结石伴陈旧性肝内胆管出血——本期读片窗答案

患者女性,22岁,工人。间歇性上腹痛五年,全身皮肤巩膜黄染一周余,初步诊断阻塞性黄疸,考虑胆囊炎,旭石症,胰头癌,胆道癌入院。入院后在电视监视下作细针经皮肝穿刺胆管造影(PTC),细针剌入胆囊内,注入造影剂后胆囊,胆总管、肝总管及右肝管均显影;胆     

先天性胆囊缺如一例报告

患者,女,58岁.间歇性右上腹隐痛1年余,先后三次B超检查均提示胆囊结石.择期手术,术中见十二指肠第一段与肝脏面粘连,分离粘连未见胆囊,仔细探查左右肝叶脏面,肝组织正常,未扪及包块.剪开肝十二指肠韧带表面的腹膜,显露胆总管(胆总管稍增粗,直径约1.2cm)、左右肝管,仍未找到胆囊及胆囊管.切开胆总管,探查无异常,置“T”管引流,30%胆影葡胺40ml经“T”管造影,肝内外胆管显影清晰.仍未见胆囊显影.术后B超复查亦无胆囊.讨论 胆道的解剖包括胆管和胆囊常有变异.其中胆囊变异少见,主要的类型有:①胆囊数量的变     

B超、双重胆囊胆道造影与手术病理133例的对照研究

本文报道133例胆系手术,术前均经B超和口服加静脉双重胆囊胆道造影检查,依据手术病理结果,对两种诊断方法进行评价。B超与口服加静脉双重胆囊胆道造影相比较,诊断胆囊结石敏感度分别为98.23％,74.76％;特异度8O％,88.89％;准确度95.49％,77.69％。结果显示,对于胆囊疾病的诊断,B超优于口服加静脉双重胆囊胆道造影。当B超检查未显示胆囊或不能作出结论,或临床高度疑有胆囊疾病而未证实时,酌情作口服胆囊造影。静脉胆道造影对诊断胆管病变价值不高。     

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。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.