ERCP后CT诊断梗阻性黄疸病因(附25例分析)

目的 评价ERCP后CT对梗阻性黄疸的诊断价值。方法 25例胆道梗阻性疾病的ERCP后行上腹部螺旋CT容积扫描，在工作站利用软件将图象处理后得到胆道系统MPR和仿真内窥镜图像。结果 25例中，胆管癌2例，砂癌2例，胆总管结石16例，胆总管炎3例，胰头囊性肿瘤1例，胆囊癌侵犯胆总管1例，均经手术或病理证实。结论 ERCP后CT扫描是诊断梗阻性黄疸的一种可靠手段。     

内镜逆行胰胆管造影对胆总管癌的诊断与治疗价值

目的：探讨内镜逆行胰胆管造影（ERCP）对胆总管癌的诊断与治疗价值.方法：回顾性总结分析，2006年5-10月36例诊断与治疗性ERCP临床资料.结果：上段胆总管癌18例，中段胆总管癌6例，下段胆总管癌12例，并行相应的置胆道内外支架、ENBD、十二指肠乳头切开等治疗.结论：通过ERCP方法可清晰地显示胆道系统的X线解剖学结构.特别是在早期诊断肝外胆管占位方面有独特的优越性，其诊断率约在90%以上.通过ERCP来了解梗阻性黄疸的性质、梗阻的部位并对选择治疗方案有重要的临床意义.     

双层螺旋CT对肝外胆道梗阻性疾病的病因诊断

目的：评价CT对肝外胆道梗阻性疾病的病因诊断价值。方法：肝外胆道梗阻性疾病184例，全部行肝胆胰CT常规扫描。部分病例分别行双期增强扫描、薄层双期增强扫描。结果：CT正确诊断169例，其中良性111例，恶性58例。结论：CT对大部分肝外胆道梗阻性疾病的病因可作出正确诊断。诊断率约91．85％。     

梗阻性黄疸的CT诊断分析

目的探讨CT诊断在梗阻性黄疸中的诊断价值,以提高诊断水平。方法对30例经临床、手术、病理证实的梗阻性黄疸病例的CT影像学资料进行回顾性分析。结果 30例梗阻性黄疸中,均有不同程度肝内外胆管扩张。良性梗阻13例:胆管炎2例,胆道结石11例;恶性梗阻17例:肝门部胆管癌4例,胆囊癌局部浸润2例,胆囊癌术后局部复发1例,肝门部淋巴结转移2例,胆总管癌4例,胰头癌3例,壶腹癌1例。结论 CT对梗阻性黄疸定位、定性诊断具有较高价值。     

16层螺旋CT多平面及曲面重建技术诊断27例梗阻性黄疸分析

目的探讨16层螺旋CT多平面重建（MPR）和曲面重建（CPR）在阻塞性黄疸诊断中的临床应用价值。方法对27例梗阻性黄疸病例行螺旋CT平扫,通过MPR及CPR技术对梗阻部位及性质进行诊断,并与手术、病理对照。结果27例梗阻性黄疸中,胆管癌4例,胰腺癌6例,胆总管结石15例,胆总管炎性狭窄2例。CT结合MPR、CPR诊断准确率为88.8%,良、恶性梗阻的鉴别诊断准确率为88.8%。结论多层螺旋CT平扫结合MPR和CPR图像后期处理技术,能准确显示胆道梗阻的部位和程度,直观地显示病变的范围及与周围组织的关系,对胆道系统梗阻病变的定位、定性具有很高的诊断价值。     

ERCP对可疑胆道疾病的诊治价值

目的探讨ERCP对可疑胆道疾病的诊治价值。方法对近3年该科应用ERCP及相关技术诊断及治疗可疑胆道疾病患者进行分析研究。结果53例可疑胆道疾病经B超、CT或MRCP检查未得出明确诊断,经ERCP检查未见异常3例,行EST50例,其中乳头狭窄20例,胆总管末端小结石22例,8例乳头或壶腹癌,均经病理证实,该组病例中ERCP全部成功,无严重合并症。结论B超,CT或MRCP无法完全代替ERCP,ERCP及相关技术对可疑胆道疾病是安全、有效的诊断及治疗方法,但要严格掌握适应证。     

肝外胆道梗阻的CT和MRI分析

目的探讨肝外胆道梗阻的多层螺旋CT和磁共振影像特征。方法选择经手术和病理证实的65例肝外胆道梗阻性病变患者,其中肝外胆道结石21例,慢性胰头炎2例,恶性胆道梗阻42例。使用多层螺旋CT多期增强扫描47例。使用1.5T超导MRI扫描仪检查18例,SE序列常规T1WI和T2WI横断和冠状面成像,MRCP使用单次激发厚层投射技术。结果47例中MSCT显示轻度胆总管及肝内胆管扩张3例,中度12例,重度32例,对肝外胆管梗阻程度的判断和定位准确率为97.9%,定性诊断准确率为87.2%。18例MRCP胆胰管显示满意,对肝外胆管梗阻程度的判断和定位准确率为100%,结合常规MRI图像定性诊断准确率为88.9%。结论MSCT与MRI检查可以对肝外胆道梗阻作出早期诊断,特别以MRCP能清楚显示扩张胆管的部位、形态及与周围组织结构的关系,优于CT。     

内镜下胆管支架植入术治疗胆道梗阻的临床价值

目的分析应用内镜逆行胰胆管造影术(ERCP)联合十二指肠乳头括约肌切开术(EST)、内镜下胆管金属支架引流术(EMBD)/内镜下胆管塑料支架引流术(ERBD)治疗胆道梗阻的临床价值。方法回顾性分析65例胆道梗阻患者,其中胆总管结石29例,肝门、肝总管及胆总管癌14例,胰头癌伴/不伴十二指肠浸润5例,壶腹周围癌3例,胆总管炎性狭窄、乳头口缩窄5例,乳头结石嵌顿伴瘘口形成4例,胆道金属支架置入术后支架堵塞3例,胆道出血2例。均行EST并取石、EMBD或ERBD治疗,观察其临床效果以及并发症。结果 63例获得成功,成功率96.9%。1例肝门部肿瘤、1例胆管上段肿瘤治疗失败后转外科行经皮肝穿刺胆道引流术(PTCD),胆管肿瘤患者因多器官功能衰竭死亡,死亡率为1.5%。术后6例轻微发热,发热率为9.6%,11例上腹隐痛,隐痛发生率为17.7%,均经对症处理后缓解。所有63例患者术后3d后复查肝功均有不同程度好转,于术后7～10d出院,平均住院日为8.7d。结论 ERCP联合EST、EMBD/ERBD治疗胆道梗阻具有安全有效、创伤小、痛苦小、住院时间短、并发症少、死亡率低、患者恢复快的优点,是目前治疗胆道梗阻的理想方法,值得推广应用。     

ERCP对胆总管下段及周围疾病的诊断价值

目的 :探讨内镜逆行胰胆管造影 (ERCP)对胆总管下段及周围疾病的诊断价值。方法 :所有患者均行ERCT及B超检查 ,部分患者行CT检查。并将ERCP与B超、CT对胆总管下段疾病诊断结果进行比较。结果 :6 1例均由ERCP确诊并经手术或病理证实 ,其中胆总管结石 4 1例、胆总管癌 6例、壶腹部癌 5例、胰头癌6例、十二指肠乳头炎 2例、胆总管胆泥沉积 1例。ERCP对结石及肿瘤的诊断分别为 97.5 %、90 .9%与CT6 6 .6 %、33.3% ;B超 5 8.5 %、36 .3%比较 ,差异显著 (P <0 .0 1)。结论 :ERCP可清晰地观察整个胰胆管形态 ,对胆道及壶腹部肿瘤、胆总管下段结石具有重要诊断价值。     

CT在梗阻性黄疸患者中的诊断价值

目的：探讨CT对恶性梗阻性黄疸的诊断价值。方法：回顾性分析和总结本院经手术病理证实的45例恶性梗阻性黄疽的CT征象资料。结果：本组中肝门胆管癌10例，胆囊癌10例，胆总管下段癌11例，壶腹癌1例，胰头癌7例，十二指肠乳头癌5例，肝尾叶癌1例。恶性胆道梗阻的CT表现有：肝内及肝门部胆管扩张、胆总管扩张，表现为“软藤征”，“截断征”等。结论：CT是诊断梗阻性黄疸的重要方法之一，具有重要的临床价值。CT对梗阻性黄疸有极高的定位与定性诊断价值，但在具体病因确定上有一定局限性。     

Carcinoma of the gallbladder associated with clonorchiasis: clinicopathologic and CT evaluation

BACKGROUND: The computed tomographic (CT) features of three cases with pathologically proven adenocarcinoma of the gallbladder associated with clonorchiasis. METHODS: CT scans of three cases with pathologically proven adenocarcinoma of the gallbladder associated with clonorchiasis were retrospectively reviewed. Scans were analyzed for the following parameters: (a) gross morphologic pattern (intralumenal mass lesion, mass replacing the gallbladder, focal or diffuse wall thickening); (b) contrast enhancement of the tumors; (c) associated gallstones or Chlonorchis sinensis worms; (d) direct invasion into the liver; (e) metastasis to adjacent viscera (pancreas, duodenum); (f) the extrahepatic bile duct (dilatation, metastasis, stone, C. sinensis worms); (g) the intrahepatic bile duct (dilatation); and (h) lymphadenopathy and metastasis. RESULTS: The gross morphologic pattern of three cases with carcinoma of the gallbladder was an intralumenal mass lesion (the least common type), whereas the patterns of infiltration and a mass replacing the gallbladder were not identified. Mild contrast enhancement of the tumors relative to the liver was demonstrated in all patients. Gallstones and C. sinensis worms were not visualized in the gallbladder and the extrahepatic bile duct. An unusual metastasis to the distal common bile duct and the pancreas was found in this series. CONCLUSION: Three cases with adenocarcinoma of the gallbladder associated with clonorchiasis showed intralumenal mass lesions within the gallbladder lumen. The cause-and-effect relation between clonorchiasis and gallbladder carcinoma is discussed.     

Extrahepatic cholangiocarcinoma associated with clonorchiasis: CT evaluation

BACKGROUND: I evaluated the computed tomographic (CT) features of nine pathologically proven cases of cholangiocarcinoma in the extrahepatic bile duct associated with clonorchiasis. METHODS: CT scans of nine pathologically proven cholangiocarcinoma associated with clonorchiasis were reviewed retrospectively. CT scans were analyzed for the following parameters: tumor (detection, location, gross morphologic type, contrast enhancement), intrahepatic bile duct (dilatation, pattern of dilatation), common bile duct (dilatation, Clonorchis sinensis worms), gallbladder (inflammation, C. sinensis worms), invasion of the contiguous viscera (pancreas, duodenum, liver), lobar atrophy, and lymphadenopathy and metastasis. RESULTS: CT depicted the level and cause of obstruction in all nine patients (100%). Contrast enhancement of the tumors relative to the liver parenchyma showed isoattenuation in five tumors (55%) and hyperattenuation in four tumors (44%). Severe, uniform dilatation of the intrahepatic bile duct was identified in six patients (67%) and central dilatation was seen in two patients (22%). No evidence of dilatation of the intrahepatic bile duct was seen in one patent (11%). Most tumors were located in the proximal third of the extrahepatic bile duct ( n = 7, 78%). Male preponderance was found ( n = 8, 89%). CONCLUSION: Cholangiocarcinoma associated with clonorchiasis was located predominantly in the proximal third of the extrahepatic bile duct and detected more readily than nonclonorchiasis-associated cholangiocarcinoma.     

十二指肠乳头区肿瘤71例超声诊断价值

目的 总结十二指肠乳头区肿瘤的超声特点,探讨超声对十二指肠乳头区肿瘤的诊断价值。方法 回顾性分析了1991－2001年经手术和病理证实的71例十二指肠乳头区肿瘤。结果 术前超声诊断为十二指肠乳头肿瘤51例（71．8％）,误诊胰头癌4例,误诊胆管末端癌5例,误诊为胆总管结石2例,误诊为壶腹部结石1例,诊断胃扩张2例,提示胰胆管扩张,胆囊增大6例。超声在十二指肠乳头区肿瘤定位诊断中的准确性与检查的手法及经验密切相关,本组超声定位准确率88．7％,高于CT（84％）,低于ERCP（96％）。超声为目前诊断十二指肠乳头区肿瘤首选的最佳方法。结论 超声和ERCP联合检查可提高十二指肠乳头区肿瘤检出率。     

Spread of gallbladder carcinoma: CT evaluation with pathologic correlation

Background: To assess the accuracy of computed tomographic (CT) imaging in the detection of spread and staging of gallbladder carcinoma. Methods: CT findings of spread of gallbladder carcinoma in 59 Japanese patients who underwent radical surgery were correlated retrospectively with pathologic findings. Results: The incidence of histologically proven nodal involvement was 54% (32 patients) and the most common spread of gallbladder carcinoma. The sensitivities in CT detection of N1 and N2 nodal involvement were 36% and 47%, respectively; positive predictive values were 94% and 92%, respectively. Direct extension to the liver, extrahepatic bile duct, and gastrointestinal tract or pancreas were histologically confirmed in 24, 18, and five patients. The sensitivities in the CT detection of direct spread to the liver of less than 2 cm, more than 2 cm, the extrahepatic bile duct, and the gastrointestinal tract or pancreas were 65%, 100%, 50%, and 57%, respectively; positive predictive values were 77%, 100%, 90%, and 100%, respectively. The incidence of liver metastases and involvement of interaortocaval nodes were 7% and 16%, respectively. The sensitivities in CT detection of liver metastases and involvement of interaortocaval nodes were 75% and 21%, respectively; positive predictive values were 100% and 86%, respectively. CT could not detect direct spread to omentum and peritoneal seedings. Conclusion: For detecting the spread of gallbladder carcinoma, CT imaging has low to moderate sensitivity; however, CT imaging can help in determining resectability and in planning the treatment, especially in advanced-stage gallbladder carcinoma, because of a high positive predictive value. Received: 5 July 1995/Accepted: 8 August 1995     

内镜逆行胰胆管造影术取石失败后即行腹腔镜胆总管探查术的临床观察

目的对于胆囊结石合并肝外胆管结石患者,探讨内镜逆行胰胆管造影术(ERCP)治疗肝外胆管结石不成功时如何选择治疗方式及时机。方法 12例胆囊结石合并肝外胆管结石拟分期行腹腔镜胆囊切除术(LC)+ERCP患者,行常规ERCP治疗失败,立即静吸复合全麻下完成LC+胆管探查取石术(LCBDE)。结果12例患者均顺利完成LC+LCBDE,并取净结石。术后3例出现高淀粉血症,全组无胆漏、肠漏、胆管炎、胰腺炎和胆道出血等并发症发生。结论对于ERCP治疗不成功的患者,急诊行LCBDE是安全、可行的补救措施。     

ERCP: current uses and less-invasive options

Endoscopic retrograde cholangiopancreatography (ERCP) is well suited for the evaluation and treatment of diseases of the bile ducts and pancreas, but it carries the risk of inducing pancreatitis. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography have exceptional value in imaging the gallbladder, common hepatic duct, common bile duct, and pancreas. These imaging studies have replaced ERCP for diagnostic purposes in patients with a low pretest probability of finding lesions amenable to endoscopic therapy, such as bile duct stones.     

Effect of aging on the adult extrahepatic bile duct: a sonographic study.

OBJECTIVE: To determine whether the size of the extrahepatic bile duct increases with age in adults. METHODS: We prospectively collected data on 251 patients aged 20 years or older who underwent abdominal sonography. None of the patients had a history of liver, gallbladder, biliary, or pancreatic disease or surgery. The extrahepatic bile duct was measured at 3 locations: in the porta hepatis, in the most distal aspect of the head of the pancreas, and midway between these points. Least squares linear regression was used to correlate patient age and the size of the extrahepatic bile duct. RESULTS: There were 126 men and 125 women aged 20 to 94 years (mean +/- SD, 52.5 +/- 17.63 years). Twelve percent of the study population were younger than 30 years, and 12% were older than 80 years. The mean diameters of the common bile duct in the 3 locations were as follows: proximal, 3.39 +/- 1.14 mm; middle, 3.72 +/- 1.28 mm; and distal, 4.28 +/- 1.18 mm. The overall mean for all measures was 3.66 +/- 1.15 mm. The width of the common bile duct ranged from 1.0 to 8.6 mm. There was a significant correlation between common bile duct size and age (r = 0.535; P < .001). Mean common bile duct sizes were 3.128 +/- 0.862 mm in the patients younger than 50 years and 4.19 +/- 1.15 mm in the patients older than 50 years (P < .001 by independent t test for equality of means). We have found that the duct gradually dilated 0.04 mm/y. CONCLUSIONS: This study revealed an age-dependent change in the diameter of the extrahepatic bile duct. We suggest that the upper normal limit of the duct in elderly persons be set at 8.5 mm.     

Bile duct disease: Prospective comparison of ERCP,CT, and fat suppression MRI

The authors compared computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP), techniques commonly used to study the biliary tree, with pre- and post-Gd-DTPA breath-hold fast low angle shot (FLASH) and fat suppressed spin-echo in 28 consecutive patients with bile duct abnormalities detected on ERCP, including 11 patients with malignant disease and 17 patients with benign disease. ERCP, CT, and magnetic resonance (MR) images were prospectively interpreted in a blinded fashion and reviewed by consensus. ERCP characterized all cases of malignant disease by the presence of a narrowed bile duct lumen with irregular margins. CT and MRI detected all cases of malignant disease and characterized nine of 11 as malignant. In seven of these cases, CT and MRI showed thickening of extrahepatic bile duct walls >5 mm. MRI images showed intrahepatic-enhancing periportal tissue in four cases, which was not seen on CT images, and which was biopsyproven tumor extension. Benign disease was characterized on ERCP images by the demonstration of smooth tapered narrowings in 16 cases, whereas on CT and MR images it was characterized by mild to moderate dilatation of the intrahepatic bile ducts and wall thickness < 5 mm in 13 cases. Overall ERCP correctly characterized 27 cases as benign or malignant and CT and MRI both characterized 25. The results of this study show a trend that ERCP is superior to CT and MRI for characterizing bile duct disease.     

胆总管下段癌的腔内超声与ERCP诊断价值比较

目的比较内镜超声(EUS)、胆管腔内超声(IDUS)与内镜下逆行胰胆管造影(ERCP)对胆总管下段癌的诊断价值.方法回顾分析上海长海医院1999年8月至2003年8月期间,同期施行EUS、IDUS和ERCP检查,并经手术标本病理证实的42例胆总管下段癌患者的病例资料,比较EUS、IDUS和ERCP的诊断价值.结果 42例患者中,男24例,女18例,平均年龄53.9岁.EUS检出39例(92.9%),IDUS检出42例(100%),ERCP检出40例(95.2%),三者检出率差异无统计学意义(P>0.05).EUS漏检的3例病灶均局限于胆管壁,但被IDUS确诊.结论 EUS与ERCP对胆总管下段癌具有相当的检出率, EUS和ERCP联合IDUS可提高早期胆总管下段癌的诊断水平.