对肝外胆管梗阻时“软藤征”的再认识

本文回顾性分析了48例“软藤征”的病因,其中恶性疾病28例(占58.3％),良性疾病20例(占41.7％)。据本文资料,作者认为“软藤征”是肝管分叉部及肝外胆管急性完全(或接近完全)性梗阻时肝内胆管扩张的特征性X线表现,并非恶性梗阻特有,良性梗阻亦常见。作者指出,只要肝内胆管无或仅有轻度炎症,胆管具有良好的弹性和扩张性,不论良、恶性病变都可出现“软藤征”。那种认为当梗阻病变未显示时,仅根据“软藤征”即可作出恶性梗阻诊断的观点很值得商榷。作者认为,“软藤征”的定性及病因诊断主要应根据PTC或ERCP,或二者联合显示梗阻局部病变的形态学特征来确定。

A Restudy on "Soft Rattan Sign" with the Obstructive Lesions of Extrahepatic Bile Duct

This is a retrospective analyses of 48 cases of "soft rattan sign" with the obstructive lesions of extrahepatic bile duct. The malignant obstructive lesions were found in 28 cases (58.3%), while the benign ones in 20 cases (41.7%). The authors think that the "soft rattan sign" is a characteristic X-ray sign of the intrahepatic bile ducts when acute complete obstruction happens in the hepatic bifurcation and extrabepatic bile duct, but this sign is not peculiar to malighant obstruction, and is common to benign obstruction as well. The authors point out that if intrahepatic bile ducts, without or with slight inflammation, retain good elasticity, any acute extrahcpatic biliary obstruction can cause "soft rattan sign". Some athours maintain that when obstructive lesions of bile duct are not demonstrated on PTC, the malignant lesions may be diagnosed by the "soft rattan sign". This viewpoint needs furthcr discussion and consideration. The authors believe that the diagnosis to determine the nature of the"soft rattan sign" mainly depends on demonstrating morphologic characteristics of local obstructive lesions by PTC/ERCP, or both of them.