CT及ERCP对肝吸虫性急性胆道梗阻诊断价值的探讨

目的探讨CT及内镜下逆行胰胆管造影（ERCP）对肝吸虫性胆道梗阻的价值。方法回顾手术证实的肝吸虫及其团块引起的急性胆道梗阻47例，其中由内镜下十二指肠乳头括约肌（Oddi＇s括约肌）切开术（EST）证实20例，胆总管探查术证实27例，分析其研及ERCP特点。结果43例患者见不同程度的弥漫性肝内胆管从肝门向被膜方向均匀扩张，39例轻中度肝外胆管扩张，两者扩张不成比例。41例被膜下胆管末端呈囊状或杵状扩张。38例胆囊扩大，9例胆囊内可见软组织团块影。13例见胰腺肿胀，8例见胰管扩张。20例ERCP中16例见肝外胆管轻中度扩张，18例见肝内胆管呈迂曲扩张延伸，末梢呈囊状扩张，可见肝内扩张小胆管突然中断征象，在胆管内可见泥沙样、絮状不规则充盈缺损。3例见肝囊肿与扩张胆管相通。同时20例行FAT术，成功解除梗阻。结论急性梗阻性黄疸患者，CT显示肝内胆管均匀弥漫扩张，肝内胆管末端呈囊状改变，伴或不伴肝外胆管扩张，可诊断肝吸虫性梗阻。ERCP可通过抽取胆汁，找到肝吸虫或其虫卵而证实，并可通过FNT术解除梗阻。

The Values of CT and ERCP in Acute Biliary Tract Obstruction Associated with Clonorchiasis

Objective To investigate the values of computed tomography(CT) and endoscopic retrograde cholangiopanc reatography(ERCP) in acute biliary tract obstruction associated with Clonorchiasis. Methods The image features of 47 patients with acute biliary tract obstruction associated with Clonorchiasis proved by operation (27 cases) and ERCP (20 cases) were reviewed retrospectively. Results Fourty-three cases showed equal intrahepatic bile duct diffuse dilatation from porta hepatis to capusle with different levels in CT, and 39 cases showed extrahepatic bile duct dilatation. There was no significant relationship for the extent of intra and extrahepatic bile duct dilatation. It showed the end of intrahepatic bile duct shaped like a bag in 41 cases, a enlarged gallbladder in 38 cases, and 9 cases with a soft intralumenal masses. There were 13 patients with pancreas swelling and 8 with pancreatic duct dilatation. Of the 20 patients underwent ERCP, eighteen cases showed intrahepatic bile duct diffuse dilatation with the end shaped like a bag, and 16 showed extrahepatic bile duct dilatation. Irregular filling-defect was seen in the common bile duct in 9 cases. The obstruction were relieved after Oddi's muscle endoscopic sphincrectomy(EST). Conclusion The patients with acute obstructive jaundice can be diagnosed as Clonorchiasis, if CT or ERCP showed equal intrahepatic bile duct diffuse dilatation with the end shaped like a bag and with extrahepatic bile duct dilatation, which can be confirmed by the worms and eggs found in the drawing-out bile, and the obstruction can be relived by EST.