十二指肠乳头旁憩室致梗阻性黄疸的CT表现

目的探讨多层螺旋CT对十二指肠乳头旁憩室所致梗阻性黄疸的CT表现，提高对该病的诊断及鉴别诊断水平。方法本组20例中，男12例，女8例，憩室均发生于十二指肠乳头周围2cm范围内。所有病例均为突发性黄疸，13例伴右上腹痛，7例伴全腹压痛及反跳痛，12例为上消化道慢性炎症急性发作，10例有上消化道溃疡史，疼痛无规律性，制酸药物不能缓解。以双盲法的形式，分别由2位资深影像学医师对本组病例的CT表现进行回顾性分析，并与上消化道钡餐造影、十二指肠镜检查及手术结果对照。结果本组病例中有十二指肠乳头旁憩室28个，单发15例，多发（2～3个）5例。憩室形态、大小差异较大，最小者0．5cm×0．6cm，最大者8．0cm×9．0cm。15个憩室内见气液平面，20例均显示胆总管和（或）胰管扩张。本组病例螺旋CT扫描及重建显示效果较好，可清楚显示十二指肠乳头旁憩室内羽毛状黏膜及炎性改变所致梗阻性黄疸的CT异常表现，与手术、上消化道钡餐造影及十二指肠镜所见基本符合。本组误漏诊2例，其他病例定位、定性均准确。结论多层螺旋CT作为一种无创性检查技术，对十二指肠乳头旁憩室所致梗阻性黄疸的CT表现有较高的特征性，对其诊断及鉴别诊断有较高的临床应用价值。

CT manifestatiOn of obstructive jaundice caused by duodenal papillary diverticula

Objective To explore the CT manifestation of obstructive jaundice caused by duodenal diverticula with multi-slice spiral CT scan, in order to improve the skills of diagnosis and differential diagnosis of this disease. Meth- otis Among 20 cases in this group, 12 cases were male, 8 cases were female. All diverticula were located in less than 2 cm from the duodenal papilla. Sudden jaundice occurred in all cases; right upper abdominal pain occurred in 13 cases, 7 cases with abdominal tenderness and rebound tenderness. 12 cases were due to acute attack of chronic upper digestive inflammation, 10 patients had a history of upper digestive ulcers, in which, pain was irregular, and anti-acid drugs were not alleviative. Double-blind method was adopted. Two experienced imaging physician retrospectively ana- lyzed CT scans and compared with findings of upper digestive barium examination, endoscopic findings and operations Results In this group, 28 duodenal diverticula were observed, single in 15 cases, multiple （2-3） in five cases. The dif- ference of shape and size of diverticula were significant, in which, the smallest one was 0.5cm ×0.6cm, and the largest was 8.0 cm×9.0cm. Air fluid level was found in 15 cases, dilatation of choledoch and/or pancreatic duct were seen in 20 cases. In this study, the imaging of spiral CT scanning and reconstruction were very good, and the CT abnormalities of feathers like mucosa in duodenal diverticula and inflammatory changes caused by obstructive jaundice can be clear- ly observed, which was basically in accordance with the manifestation showed in operation, upper digestive barium imaging and endoscopic findings. Two cases were misdiagnosed, and the location and characteristics of diseases in oth- er cases were all accurate. Conclusion Multi-slice CT as a noninvasive technology has a higher characteristic CT find- ing for obstructive jaundice caused by duodenal,diverticula, and has high clinical value for diagnosis and differential diagnosis of obstructive jaundice caused by duodenal papillary diverticulla.