黏胆症临床文献复习及诊治分析80例

目的:探讨国内黏胆症的流行病学、诊断、治疗等情况,为临床医生提供借鉴.方法:将文献数据全部统计后,无重叠病例者全部选用;重叠病例选用时间跨度最长、病例数最多的文献.共查到有效统计文献12篇,加上我院病例,一共80例.其中报告5例以上的文献4篇,病例数最多的为22例.结果:黏胆症术前诊断困难,临床误诊率高达48%,与一般外科性质梗阻性黄疸相比,并无显著特异性,但其预后欠佳,1年死亡率为16.44%.术前诊断主要依靠临床表现及超声、CT、ERCP、PTC等辅助检查,术中胆道探查发现胆管腔内大量胶冻样黏液,则黏胆症诊断成立.结论:黏胆症临床上少见,但其有着较广的病因分布,纤维胆道镜和活体组织检查可明确诊断原发病变的部位、范围和性质.黏胆症预后欠佳,彻底切除原发病灶、保证胆道通畅引流是首选的治疗方法.

Diagnosis and treatment of mucobilia:A review and analysis of 80 cases

AIM:To discuss the epidemiology,diagnosis,and treatment of mucobilia in China to provide a reference for clinicians.METHODS:All statistical data were obtained from the available literature.Non-overlapping cases were all selected,while cases with the longest time span or with the largest number were selected when overlapping cases existed.A total of 12 papers were included,and 4 of them reported more than 5 cases.The largest number of cases in a single paper is 22.RESULTS:A total of 12 qualified papers re-porting 80 cases of mucobilia were included.Preoperative diagnosis of mucobilia is difficult.The rate of misdiagnosis reached 48%,and mucobilia has no significant specificity compared with some diseases presenting with benign and malignant obstructive jaundice.The annual mortality rate was 16.44%.Preoperative diagnosis mainly depends on clinical presentation and ultrasound,CT,ERCP,PTC and other auxiliary examinations.If intraoperative bile duct exploration reveals a large amount of jelly-like mucus in the cavity,a diagnosis of mucobilia can be established.CONCLUSION:Mucobilia is a rare biliary disease having many causes such as in? ammation of the bile duct and carcinoma of the bile duct.The location,extent and nature of the primary disease can be conf irmed by choledochofiberscopy and biopsy.Preferred treatment is a complete resection of primary lesions to ensure both good and smooth drainage of the bile duct.