先天性胆总管囊肿的超声诊断

目的：探讨超声对先天性胆总管囊肿的诊断价值。方法：分析21例先天性胆总管囊肿．采用超声观察囊肿的部位、大小、形态、结石与癌变情况。所有病例均经手术和病理证实。结果：肝外型胆总管囊肿18例，混合型胆管囊肿3例．合并胆总管结石5例，癌变3例。超声诊断符合率为95．2％(20／21)，结论：超声检查不仅是诊断先天性胆总管囊肿的可靠方法．而且对明确囊肿有无结石、特别是有无癌变，以及确定手术治疗。方案具有重要实用价值。     

彩色多普勒超声诊断先天性胆总管囊肿

目的 探讨彩色多普勒超声对先天性胆总管囊肿的诊断价值.方法用彩色多普勒超声检查31例先天性胆总管囊肿患者,观察囊肿大小、部位、形态,有无结石或肿块等.所有病例均经手术和病例证实.结果肝外型胆总管囊肿26例,混合性胆管囊肿5例合并胆总管结石5例,癌变2例.超声诊断符合率为96.8%（30/31）.结论 彩超检查不仅是诊断先天性胆总管囊肿的可靠方法,而且对明确囊肿有无结石,尤其是有无癌变,确定手术治疗方案具有重要价值.     

超声诊断先天性胆管囊肿及其癌变的价值

目的 探讨超声诊断先天性胆管囊肿及其癌变的临床价值。方法 先天性胆管囊肿22例，男10例，女12例。超声检查观察囊肿的部位、大小、形态、合并炎症、结石与癌变等情况，并与手术病理检查结果进行对比研究。结果 超声检查诊断为先天性胆管囊肿22例，其中肝外型胆管囊肿54．5％(12／22)、混合型胆管囊肿45．5％(10／22)。其中单纯囊肿22．7％(5／22)，囊肿合并炎症77．3％(17／22)，合并结石54．5％(12／22)，癌变22．7％(5／22)。与手术病理对照，结果 除1例超声诊断为先天性胆总管囊肿而手术证实为肝总管囊肿，其部位略有差异外，其余全部符合。结论 超声检查不仅是诊断先天性胆管囊肿的可靠方法，而且对明确囊肿有无合并炎症、结石，特别是癌变，有重要的临床实用价值。     

先天性胆总管囊肿超声表现4例报告

先天性胆总管囊肿的诊断，由于多发生在肝门部，有的囊肿较大而圆，而连通的胆管多细且深，由于胃肠气体干扰，超声很难清楚显示，易发生潜心诊、误诊，因此我院对4例典型先天性胆总管囊肿病例，通过口服我院自制中药胃显影剂，清除胃肠气体，使图像较前清晰，通过探查，得以明确诊断，且个别病例已经CT及胆管造影得以证实，现将超声诊断分析如下。     

小儿先天性胆管囊肿的CT诊断（附21例报告）

目的 探讨小儿先天性胆管囊肿的CT诊断及鉴别诊断。方法 对21例经手术和/或病理证实的资料完整的小儿胆管囊肿病例进行回顾性分析。结果 21例先天性胆管囊肿的CT表现如下：（1）单纯胆总管囊性扩张13例,表现为肝门区或胰头区附近圆形的水样密度灶,增强囊内无变化。（2）肝内胆管多发囊性扩张2例,表现为肝内多个囊并且太,梭状低密度灶,增强后,可见其内有中心点状及树枝状明显强化灶。（3）肝内外胆管多发囊性扩张6例,同时具有以上两种征象,本病需与胰头囊肿,右肾囊肿,肠系膜囊肿,肝内单发或多发囊肿,梗阻性肝内胆管扩张等病鉴别。结论 CT是诊断小儿先天性胆管囊肿的重要方法。     

先天性胆管扩张症45例影像学诊断分析

目的通过与磁共振胆胰管成像(MRCP)对照分析45例先天性胆管扩张症的超声声像图特征及漏诊原因。方法对45例先天性胆管扩张症的超声(US)与MRCP检查结果进行对照分析。结果本组病例超声检查正确诊断率为91.1%。先天性胆管扩张症的超声声像图表现根据胆管扩张形态、累及范围分为:胆总管囊性扩张型(Ⅰ型)(84.4%),肝内、外胆管扩张型(Ⅳ型)(13.3%),肝内胆管囊性扩张型(Ⅴ型)(2.2%)。结论Ⅰ型先天性胆管扩张症因表现为典型超声声像图特征,故其诊断符合率较高(97.4%);Ⅳ型肝内、外胆管轻度不规则扩张及Ⅴ型肝内胆管多发囊性扩张,超声诊断易漏、误诊为肝内、外扩张及肝多发囊肿。     

小儿先天性胆管囊性扩张症的B超诊断(附22例报告)

本文对22例小儿先天性胆管囊性扩张进行了超声诊断。其中16例经手术或尸检证实而其余经X线检查证实。本组胆管扩张有肝内型、肝外型及混合型等三类。超声扫查可提供有关胆管扩张并与胆囊管、胆总管相连通的诊断特征。若仅有巨大无回声区而不能查证与胆管相连,应采用其他检查进行鉴别。     

MRI及MRCP在先天性胆管囊肿及合并症中的诊断价值

目的探讨磁共振成像（MRI）及磁共振胆胰管成像（MPCP）对先天性胆管囊肿及其合并症的诊断价值。方法回顾性分析29例经病理证实的先天性胆管囊肿患者的MRI及MRCP影像表现。结果29例先天性胆管囊肿,10例Ib型,7例Ic型表现为仅限于胆总管局限性扩张,MRCP示扩张胆总管与胆管树相通。10例IV型,2例V型表现为肝外和／或肝内及仅限于肝内多发胆管扩张,MRCP示胆管树呈多发大小不等囊柱状。合并结石7例,Ib型4例,IV型3例,表现为胆管内单发和／或多发边界清楚无强化灶。合并肿瘤3例,IV型及V型合并胆管癌各1例,表现为扩张胆管壁内强化结节;1例Ib型合并胆囊癌伴肝内多发转移。1例V型合并闭锁表现为扩张胆总管远端中断。1例VI型合并胰腺炎。MRI及MRCP能准确地做出胆管囊肿的诊断并能进行准确的分型,定位,定位准确率达100％,并能清楚显示胆管囊肿的合并症。结论MRI及MRCP检查在先天性胆管囊肿的诊断及显示其合并症中具有重要的价值。     

MRCP在先天性胆总管囊肿诊断中的价值

先天性胆管囊肿又称先天性胆管扩张症,以往放射科多采用静脉胆道造影检查,由于肠道内容物重叠常显示不清楚。磁共振胰胆管成像（MRCP）近年来已广泛应用于胰胆管疾病的检查。MRCP可多方位、多角度观察,立体显示肝内外胆管解剖,能清晰显示胆管扩张程度、范围及大小,对先天性胆总管囊肿的诊断有重要意义。现将一组经手术病理证实为先天性胆管囊肿病例的MRCP表现作一回顾性分析。报告如下。     

先天性胆总管囊肿合并胆道及肝胰病变的影像学诊断

目的 探讨先天性胆总管囊肿(CCC)伴发胆道、肝脏及胰腺病变的影像学表现特征。方法 回顾性分析经手术证实的47例CCC多普勒超声及CT表现，47例均行多普勒超声检查，CT扫描13例。结果 CCCⅠ型29例，Ⅱ型3例，Ⅳ型9例，Ⅴ型6例：合并肝内外胆管结石13例，胆囊结石16例，胆囊炎18例，后位胆囊4例，囊肿穿孔3例，肝肿大18例，胰腺肿大17例。结论 CCC并发胆道系统结石、感染及肝胰损害机率较高，多普勒超声及CT检查不应仅满足于CCC的诊断，还应注意其合并病变。     

成人型胆管囊肿及其合并症的超声与核磁及胰胆管水成像诊断

目的　探讨成人胆管囊肿及其合并症的超声、核磁及胰胆管水成像 (MR/ MRCP)的影像表现。方法　选取胆管扩张病例进行超声及核磁检查 ,观察胆胰管内径、胆管扩张形态、管壁厚度、回声 ,并进行彩色多普勒血流检测及核磁胰胆管水成像 (MR/ MRCP)检查 ,两者结果与术后病理对照。结果　经手术证实胆管囊肿 2 0例 ,包括 :Caroli's病 2例 , 型胆总管囊肿 14例 ,呈囊性、梭形、圆柱形扩张 ;肝门部胆管囊肿 (囊肿型 ) 3例 ,胆总管上段憩室 1例 ( 型 )。合并胆囊结石 10例 ,肝内胆管、胆总管结石 8例 ;合并肝局灶性炎 3例 ,肝脓肿 1例 ;合并癌变 5例 (高、低分化腺癌 3例 ,黏液腺癌 1例 ,类癌 1例 ) ;共同管过长 (>1.5 cm) 6例。超声与 MRCP对胆管囊肿全部诊断。合并症中超声对炎变、结石、癌变诊断分别为 95 % ,10 0 % ,95 % ,而 MRCP/MR为 10 0 % ,90 % ,95 %。超声对结石、癌变及管壁的微细结构观察优于 MRCP,MRCP对胆管全程显示优于超声 ,结合平扫及增强扫描诊断炎变符合率 10 0 %。结论　超声与 MR成像在成人胆管囊肿及其合并症中的诊断意义重大 ,联合应用有利于对该病的全面认识 ,便于指导临床。     

腹部几类少见囊性占位的CT表现特点及诊断

目的 通过对腹部少见类型囊性肿块的回顾性分析，探讨CT表现特点及其诊断和鉴别诊断。方法 44例7类腹部少见类型囊性肿块。均经CT平扫及增强扫描。其中，男20例，女24例，平均年龄51岁。临床腹痛36例、发现腹部包块31例、体检就诊8例。结果 囊性畸胎瘤18例，肠系膜囊肿5例，胆总管囊肿6例，胰腺囊肿6例，肾上腺囊肿4例，恶性神经鞘瘤2例，脐尿管囊肿3例。结论 腹部囊性肿块可来源于腹膜后或腹腔，CT定位、定性准确性较高，但囊性占位病变的组织来源复杂，对于少见类型囊性肿块术前定性诊断仍有很大困难，尤其是巨大囊肿的定性诊断困难尤为突出。CT定位穿刺活检可做出定性诊断。     

Choledochocele: a rare form of choledochal cyst

Choledochocele is the least common form of cystic dilatation of the biliary tree. Whether this condition is a congenital abnormality or the result of inflammation at the papilla of Vater is not clear. In most cases, the clinical presentation is that of intermittent abdominal pain, nausea, and vomiting, with biliary colic and/or jaundice. As described in our case, choledochocele has characteristic radiologic features, but the lesion can be easily overlooked if one is not aware of its distinctive appearance.     

Diagnosis and treatment of choledochocele complicated by choledocholithiasis (case report)

We report a case of choledochocele associated with choledocholithiasis. The patient became symptomatic when a gallstone was trapped within the choledochocele, causing intermittent biliary obstruction. Endoscopic retrograde cholangiography (ERC) provided the diagnosis and endoscopic sphincterotomy was performed for definite non-operative treatment. The lesion could not be identified on ultrasound even after its demonstration by ERC. The importance of direct cholangiography in the diagnosis of a choledochocele is discussed.     

小儿急腹症超声诊断价值的探讨

目的 探讨超声诊断小儿急腹症的应用价值。方法与结果 总结分析２９９例经临床及手术证实的小儿急腹症超声诊断结果,正确诊断率９０．５７％。在小儿肠套叠、胆总管囊肿及肝脾破裂等病症中正确诊断率分别为９１．７％、９４．７４％,９４．５９％。结论 实践证明,超声检查在小儿急腹症诊断中占重要的地位。     

Choledochocele: diagnosis by magnetic resonance imaging

The value of magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) is demonstrated in a case of a 22-year-old female with a small choledochocele clinically presenting with acute cholecystitis and pancreatitis. Previous abdominal sonography and computed tomography were not diagnostic. MRI and MRCP showed a cystic dilatation of the distal common bile duct, intramurally located in the second portion of the duodenum and protruding into the duodenal lumen. These findings allowed a confident diagnosis of a choledochocele. Received: 8 December 1999/Accepted: 12 January 2000     

Diagnostic pitfalls in the cholangiographic diagnosis of choledochoceles: cholangiographic quality and its effect on visualization

Background: We wanted to establish reasonable cholangiographic diagnostic criteria by determining the sensitivity of cholangiography in detecting choledochoceles and those factors that could compromise visualization of choledochoceles. Methods: Over 4 years, 21 patients (seven male, 14 female; mean age = 67 years) were confirmed as having choledochoceles on endoscopic retrograde cholangiopancreatography (ERCP). Cholangiographic diagnosis was made by following three criteria: a radiolucent halo around the distal common bile duct (CBD), bulbous dilatation of the distal CBD, and the presence of sequential morphologic changes on serial cholangiography. Any two or more combinations of these three criteria were considered enough to diagnose a choledochocele on cholangiography. We compared cholangiographic imaging findings with the ERCP results. Results: Of 21 patients with choledochoceles, nine (43%) were correctly diagnosed on cholangiography. A radiolucent halo was present in six (28%) patients; four of these cases showed optimal duodenal filling, one showed faint duodenal filling, and one showed poor duodenal filling. The shapes of the distal CBD were bulbous, conelike, and blunt. Morphologic changes such as collapsing and bulging of the choledochocele could be seen in 12 (57%) patients on serial cholangiography. Waists were seen in 11 (52%), pseudowebs in four (19%), and wrinkling of the distal CBD in seven (33%). Conclusion: Cholangiography should be obtained with optimal timing and adequate conditions to diagnose choledochocele correctly. Received: 20 January 2000/Revision accepted: 31 May 2000     

Carcinoma arising in choledochocele

BACKGROUND AND STUDY AIMS: Choledochocele has a potential for carcinogenesis, but no report has described malignant changes of the choledochocele in relation to pancreaticobiliary reflux because its anatomic form does not fit the criteria of pancreaticobiliary malunion (PBM). The aims of this study were to analyze the amylase level in bile in patients with choledochocele and to clarify whether the presence of a choledochocele predisposed to carcinoma. PATIENTS AND METHODS: Records of 2826 patients who had undergone endoscopic retrograde cholangiopancreatography between 1995 and 1999 were reviewed for the presence of choledochocele and/or periampullary carcinoma. As an evidence of pancreaticobiliary reflux, amylase activity was examined in common duct bile obtained at surgery or by endoscopy. The prevalence of periampullary carcinoma was compared between patients with and without choledochocele. RESULTS: A total of 11 patients were diagnosed as having a choledochocele. The amylase level in bile was higher in patients with choledochocele (120,922 +/- 62,269 IU/l; n = 4) than in previously examined patients with functioning gallbladders (15 +/- 24 IU/l; n = 10, P = 0.005). The prevalence of periampullary carcinoma in patients with choledochocele (27%, 3/11) was significantly higher than that in those without choledochocele (0.9%, 26/2815; P<0.0002). CONCLUSION: The bile analysis of the present study presents one possible explanation for the predisposition to carcinoma in choledochocele as bile containing amylase may stagnate in the choledochocele and then carcinoma may develop in the inner epithelium of the choledochocele by the same mechanism as that leading to carcinogenesis in patients with PBM.     

MRCP of congenital pancreaticobiliary malformation

Background Congenital pancreaticobiliary malformations are sometimes associated with acute or chronic pancreatitis and biliary carcinoma. Currently, magnetic resonance cholangiopancreatography (MRCP) is one of the first choices for investigating and diagnosing pancreaticobiliary diseases noninvasively. We compared the accuracy of conventional MRCP and endoscopic retrograde cholangiopancreatography (ERCP) in making the diagnosis of congenital pancreaticobiliary malformations. Methods In patients with pancreas divisum (n = 17), pancreaticobiliary maljunction (n = 12), choledochocele (n = 2), and annular pancreas (n = 1) who underwent ERCP and MRCP, the diagnostic accuracy and findings on MRCP were compared with those on ERCP. Results Of the 32 patients with congenital pancreaticobiliary malformations diagnosed on ERCP, 23 (72%) presented the same diagnosis on MRCP. Complete pancreas divisum was diagnosed in 73% on MRCP based on the finding of a dominant dorsal pancreatic duct crossing the lower bile duct and emptying into the duodenum without communicating with the ventral pancreatic duct. Pancreaticobiliary maljunction was diagnosed in 75% on MRCP based on the finding of an anomalous union between the common bile duct and the pancreatic duct and the existence of a long common channel. Conclusions Conventional MRCP is a useful, noninvasive tool for diagnosing congenital pancreaticobiliary malformations; and the diagnostic accuracy can be increased with three-dimensional MRCP or dynamic MRCP with secretin stimulation.