低张饮水MRCP技术在低位胆道梗阻诊断中的应用

目的探讨低张饮水MRCP技术在低位胆道梗阻诊断中的价值。方法180例低位胆道梗阻患者均进行了低张饮水MRCP与常规MRCP检查,所有病例均经手术或内镜活检病理证实。比较两种方法对低位胆道梗阻性病变的显示及正确诊断率。结果低张饮水MRCP对低位胆道梗阻性病变的显示明显优于常规MRCP（P〈0．05）;低张饮水前后MRCP对低位胆道梗阻的定性诊断准确率分别为72．8％（131／180）、92．8％（167／180）。结合MR其它成像序列,对低位胆道梗阻的定性诊断准确率分别为91．1％（164／180）、96．1％（173／180）。两位诊断医师之间的意见一致性明显提高（K=0．687、0．812）。结论低张饮水MRCP对低位胆道梗阻的诊断具有一定的优势,可作为低位胆道梗阻MRI诊断与鉴别诊断的一种补充手段。     

MRCP观察胰胆管合流解剖及意义

目的　通过MRCP观察胰胆管合流的解剖,探讨胰胆管合流异常(Pancreaticobiliary 　maljunction, PBM)的诊断。 方法　搜集MRCP 954例,观察胰胆管汇合情况及其与十二指肠壁的关系。 结果　胆总管和胰管均显影的841例,无法观察胰胆管汇合的113例。显影良好的841例中,胰胆管的汇合存在U、V、Y和合流异常4种胰胆管合流方式;其中Y型356例（42.33%,）,V型242（28.78%）,U型165（19.62%）,疑似PBM 78（9.27%）。 结论　 MRCP可观察胰胆管解剖,确诊PBM还需要其他辅助检查。     

B超、MRCP、ERCP诊断胆总管结石的对比分析

目的探讨B超、磁共振胆胰管成像（MRCP）、内镜逆行胰胆管造影术（ERCP）对胆总管结石的诊断价值。方法收集我院2007年4月至2010年9月胆总管结石患者214例,以内镜下十二指肠乳头括约肌切开术取出结石为诊断标准,对B超、MRCP、ERCP3种检查方法进行对比分析。结果 ERCP诊断胆总管结石的敏感性为99%,显著高于MRCP的90%,差异有统计学意义（χ2=15.58,P〈0.01）;MRCP的敏感性亦明显高于B超（38.5%）,差异有统计学意义（χ2=115.4,P〈0.01）。B超、MRCP、ERCP诊断胆总管结石的特异性分别为92.8%、92.9%、100%,3种诊断方法比较差异无统计学意义。MRCP诊断胆总管结石的准确性为93.3%,显著高于B超（85.6%）,差异有统计学意义（χ2=4.37,P=0.037）,但与ERCP（93.4%）比较差异无统计学意义（χ2=0.03,P=0.95）。结论 B超对于胆总管结石的诊断具有一定的准确率,可作为最基本的检查手段,MRCP和ERCP对于胆总管结石的诊断具有较高的一致性,MRCP可部分替代诊断性ERCP,ERCP具备诊断及治疗双重效果,地位不可替代。     

MRCP在腹腔镜胆囊切除术前对手术难易性评估的分析

目的对磁共振胆胰管成像(MRCP)在腹腔镜胆囊切除术(LC)手术前评估手术难易程度的效果进行分析。方法在我院2011年3月至2012年7月间收治的全部胆道疾病患者中,随机选择110例胆囊结石患者进行研究,全部病例均使用LC手术,术前进行MRCP检查。将真性胆囊息肉LC切除术的平均手术时间30 min作为评判标准,手术时间不超过30 min为正常手术,超过30 min为有一定难度的LC手术。对患者的年龄、性别、位置、胆囊体积、胆囊管的角度、胆囊壁厚度、胆囊周围的情况、胆囊管的长度、胆囊颈部是否存在结石等情况和LC手术难易程度的相关性进行分析。结果 LC手术的难易程度和患者胆囊管的长度、胆囊颈部是否存在结石有一定的相关性,和患者的年龄、性别、胆囊体积、位置、胆囊管的角度、胆囊壁厚度、胆囊周围的情况无相关性。结论在术前对患者进行常规MRCP检测,对LC手术难易程度的预测有着重要的指导意义。     

先天性雏形胆囊并胆囊管畸形1例

患者,男,42岁。间歇性上腹隐痛不适3年。以“胃病”调治2年,效果不佳。其后多次B超检查,报告为“充满型胆囊结石”或胆囊萎缩”,结果不一。在硬膜外麻醉下经右肋缘下斜切口拟行胆囊切除术,手术发现肝脏脏面胆囊窝内空虚,胆囊位置上一阑尾状结构,与肝床呈系膜样联接,走向汇入胆总管,穿刺抽吸到胆汁,即确定其为先天性胆囊畸形。予解剖分离,胆囊动脉纤细,未能仔细分解,故起源不明;胆囊管粗约0.2cm,在胆总管右前方与其并行一段(1.2cm)后汇入后者,分离切断并结扎胆囊管,切除胆囊。胆总管直径约1.0cm,余未见异常。切除之胆囊外观呈雏梨形     

胆囊管结石诊治体会

胆囊管结石诊治体会欧棣华，雷鹏举，李宏甘肃省天水市第二人民医院关键词胆囊管，结石胆囊管结石临床并不少见，诊断和治疗有一定特殊性。我院自１９８４年～１９９４年１０月，共进行治胆囊切除５１８例，其中胆管结石６１例占８，３％，现对其诊断和治疗进行初浅分析。...     

双胆囊管变异1例

肝外胆管的先天性解剖变异是造成医源性胆管损伤的重要原因，应当予以重视。胆囊管的解剖变异较大，胆囊管缺如、胆囊管开口于十二指肠、双胆囊管、胆囊后胆囊管为较罕见的胆囊管解剖变异。现就1例双胆囊管变异报道如下：     

肝管低位汇合1例并文献复习

肝管低位汇合是一种少见的先天性胆道变异。黄志强在肝内胆管解剖分型中将其列为一种变异,统计其发生率为0.5％。本文报告我院收治1例,并结合文献讨论其临床意义。 病历摘要;患者,女,67岁,以反复发作右上腹痛十余年加重二天主诉收住院。入院查体:巩膜轻度黄染,心肺(一),右上腹压痛。B超检查报告;胆囊结石(充满型)并可疑胆管结石。入院诊断:结石性胆囊炎,胆管结石。经术前准备,在硬膜外麻醉下行胆囊切除、胆总管切开取石引流     

双胆囊管畸形2例

双胆囊管变异临床罕见,发病率为0.025%,常开口于胆总管或十二指肠,也有变异至幽门者。若对双胆囊管变异病人行胆囊切除时,如未仔细探查,则遗留的远端胆囊管较长,术后可引起再生性小胆囊综合征或胆囊切除后残株炎,近端的胆囊床内仍有细小胆管未被结扎而致术后胆漏。1临床资料病例1:患者男性,68岁,因右上腹痛反复发作10年入院。曾诊断为胆囊及胆总管结石于2年前在外院行内镜下十二指肠乳头括约肌切开取石术,术后症状无明显缓解。查体:右上腹深压痛;MRCP提示胆总管轻度扩张、胆囊炎伴胆囊结石。入院诊断:胆囊结石伴慢性胆囊炎。入院后在静脉…     

胆囊下肝管的解剖及其临床意义

对135例屍体中出现的15例胆囊下肝管进行了研究,其出现率为11.1%,全部均为单支,位于胆囊窝右侧。胆囊下肝管最大外径5mm,最长5cm,与肝外胆道汇合的形式有三种,分别注入右肝管及肝总管内。本文针对胆囊下肝管来源于肝右前叶胆囊窝内的浅层肝管,提出临床上剥离胆囊时应注意的要点。     

胰胆管合流部解剖与急性胰腺炎关系的MRCP分析

目的探讨急性胰腺炎的产生与胰胆管合流部解剖的关系。方法回顾分析83例急性胰腺炎患者的MRCP片,对胰胆管合流部进行测量和分析比较;以同期139例非急性胰腺炎患者的MRCP片作为对比分析。结果急性胰腺炎组的共同通道长度明显大于对照组(P0.01);前者胰管与胆管汇合处角度也明显大于后者(P0.01);两组的肝外胆管直径和胰管直径无显著差别(P0.05)。结论急性胰腺炎的发生与胰胆管合流部的解剖密切相关,共同通道过长、胰胆管汇合角度过大是造成急性胰腺炎的重要因素。     

腹腔镜胆囊切除术3265例胆囊管变异的临床总结

目的总结中国人群胆囊管变异的临床情况并结合近20年的手术经验,为腹腔镜胆囊手术预防胆管损伤提供临床依据。方法对重庆医科大学附属第二医院及重庆重钢总医院1993年4月至2011年12月总共20 000例腹腔镜胆囊切除术患者的临床资料进行回顾性分析。结果胆囊管变异3 265例,变异率为16.33%,其中胆囊管汇入点变异3 200例,短胆囊管51例,胆囊被肝组织包绕14例。胆囊管汇入点的变异占绝大部分,其中胆囊管与肝总管平行低位汇合371例,占11.36%;胆囊管横过肝总管前面汇入995例,占30.47%;胆囊管绕过肝总管后面再汇入643例,占19.69%;胆囊颈部之囊状凸与胆总管粘在一起963例,占29.49%;胆囊管与胆总管高位汇合228例,占6.98%。结论中国人群胆囊管变异以胆囊管汇入点异常为主;临床医师术中应熟悉胆囊管变异的分型,术中仔细认清解剖结构,必要时采取术中胆道影像学检查并且掌握好中转开腹指征。     

Gartner duct cyst in pregnancy presenting as a prolapsing pelvic mass

Gartner duct cysts are the remnants of the Wolffian duct and they are rarely seen in adulthood. We present a case of a pregnant patient with a prolapsing vaginal mass. A diagnosis of Gartner duct cyst was made after MRI was performed. The Gartner duct cyst was drained when the patient went into labour allowing vaginal delivery to be performed.     

Carcinoma in situ of the cystic duct

Cholelithiasis and cholesterolosis associated with carcinoma in situ of the cystic duct epithelium was observed in a male patient. Ultrastructurally, small acini-like lined a thickened, reduplicated basal lamina encompassing a pleiomorphic population of cells, including typical chole-cystocytes, a poorly differentiated type, and cells containing modified mucous vesicles with heterogeneous fatty deposits. Even though the etiology of this apparent neoplastic epithelium and of its thickened basal lamina is unclear, it is hypothesized to be the result of an altered control of cell adhesion mechanisms, resulting from a repeated renewal of the typical epithelium abraded by the passage of the stones and the biliary sludge, associated with inflammatory stimuli that accompany cholecystolithiasis. Based on recent studies, it is suggested that investigations of molecular markers in extrahepatobiliary tract lesions and retrospective studies of these archival tissues could clarify the association of these neoplastic changes with other hepato-biliary lesions.     

One duct,two orifices,no names! the anatomy of the biliary cystic duct

The biliary cystic duct (CD) connects the gallbladder to the extra‐hepatic bile duct, and the point at which it does this delineates the division between the common hepatic duct and the common bile duct. Its clinical relevance in disease, and importance during interventions relating to the gallbladder mean that its normal and variant anatomy has been described extensively in literature. However, an aspect not yet fully described includes naming of its two orifices on either end. This is highly relevant for surgical, endoscopic, and percutaneous procedures. We describe these as encountered in normal CD and biliary tree anatomy. We believe this is crucial for interventions relating to the gallbladder and the biliary tree, including prevention of iatrogenic injury. Clin. Anat. 31:422–423, 2018. © 2018 Wiley Periodicals, Inc.     

Hybrid carcinoma of the salivary gland: salivary duct adenocarcinoma adenoid cystic carcinoma

AIMS: Hybrid tumours of the salivary gland are rare neoplasms that have been described only in the parotid and palate. Their recognition is important particularly when the component tumours have different biological behaviours. The occurrence of a submandibular hybrid tumour has not been reported. METHODS AND RESULTS: We describe a case of a 36-year-old woman with a hybrid carcinoma composed of salivary duct adenocarcinoma and adenoid cystic carcinoma of the right submandibular gland. There was no evidence of a pre-existing or concurrent pleomorphic adenoma. The presence of the two components was verified by differential immunohistochemical staining using a panel of cytokeratin, vimentin, smooth muscle actin and S100. The patient subsequently developed metastases to the pelvis, lumbar, vertebra and wrist. The clinical course in this patient was consistent with the behaviour of the salivary duct adenocarcinoma component. CONCLUSIONS: The histogenesis of hybrid tumours is largely unknown, but in this case it may represent diverging differentiation of luminal tumour cells. Because some histological features of different salivary gland tumours overlap, immunohistochemistry is a valuable tool especially when used to delineate the components of a hybrid tumour.     

Magnetic resonance thoracic ductography assessment of serial changes in the thoracic duct after the intake of a fatty meal

The thoracic duct, a terminal lymph vessel, is thought to dilate after the intake of a fatty meal. However, this physiological change has not been well explored in vivo . Therefore, the present study aimed to assess serial changes in the thoracic duct after the intake of a fatty meal using magnetic resonance thoracic ductography (MRTD ). Eight healthy volunteers were subjected to one MRTD scan before a fatty meal and eight serial MRTD scans every hour thereafter. The cross‐sectional areas of the thoracic duct were estimated using MRTD measurements of the diameters of the thoracic duct at the upper edge of the aortic arch, the tracheal bifurcation, the mid‐point between the tracheal bifurcation and the left part of the diaphragm and the left part of the diaphragm. The change‐rates in these areas were calculated before and after the fatty meal intake, and the maximal change‐rate and timing of its achievement were determined for each subject. The summed change‐rates in the four portions of the thoracic duct ranged from ?40.1 to 81.3%, with maximal change‐rates for each subject ranging from 22.8 to 81.3% (mean, 50.4%). Although individual variations were observed, most subjects (88.9%) exhibited a maximal change‐rate at 4–6 h after meal intake, with subsequent decreases at 7–8 h. In conclusion, MRTD revealed a tendency toward thoracic duct enlargement at 4–6 h after the intake of a fatty meal, followed by contraction.     

MRI常规序列及3D-SPACE序列在先天性子宫发育异常中的临床应用价值

目的探讨MRI常规序列及3D-SPACE序列在先天性子宫发育异常分型诊断中的临床应用价值。方法回顾性分析30例先天性子宫发育异常患者的MRI和临床资料,参照美国生殖学会的标准进行先天性子宫发育异常的分型诊断。结果30例先天性子宫发育异常的患者中纵隔子宫19例（完全性纵隔子宫11例,不完全性纵隔子宫8例）,双子宫3例,单角子宫2例,残角子宫1例,双角子宫2例,弓形子宫3例,并经临床或手术证实,准确率达100％。结论MRI常规序列及3D-SPACE序列可对先天性子宫发育异常的类型作出准确的诊断,是先天性子宫发育异常的最佳无创性影像检查方法。     

专用四肢关节低场MR在踝关节韧带急性损伤中的应用

目的评价专用四肢关节低场MR在踝关节韧带急性损伤中的应用价值。方法回顾分析23例踝关节急性创伤患者韧带和骨质损伤的MR表现。结果23例踝关节损伤包括外侧副韧带损伤15例、内侧副韧带损伤3例和内外侧副韧带共同受累5例,其中伴7例骨挫伤、4例骨折及10例踝骨关节炎。MR检查能全面直观显示多条韧带、骨和软骨结构损伤的范围程度。结论专用四肢关节低场MR在踝关节韧带损伤方面具有良好的应用价值,能全面评价踝关节损伤,为临床治疗提供依据。     

Clinicopathological characteristics of atypical cystic duct (ACD) of the breast: assessment of ACD as a precancerous lesion

To clarify the clinicopathological features of an atypical cystic duct (ACD) as defined by Tsuchiya's criteria as a precancerous lesion of the breast, we used 200 whole mammary gland serial sections of breast cancer. Forty-four (22%) of the 200 breast cancer patients had ACD breast lesions. The frequency of patients with ACD increased in premenopausal women (P = 0.001). There was no correlation between the ACD-present group and the ACD-absent group for immunohistochemical status of the estrogen receptor (ER), progesterone receptor (PgR), p53, or c-erbB2; Ki-67 labeling index of cancer tissues; size of tumor, or lymph node metastases. A number of ACD lesions displayed continuity to cancer lesions. In 500 serial sections of a paraffin-embedded tissue of a ACD case at 3 microm intervals, an apparent transition from ACD into ductal carcinoma in situ was observed. Immunohistochemical analysis using alpha-smooth muscle actin showed that myoepithelial cells of ACD stained strongly, and their nuclei and cytoplasm were thinning. In 16 of the 44 (36%) ACD-present patients, carcinoma cells stained positive for p53. Within those 16 cases, 12 cases (75%) were positive for p53 in ACD lesions. There was a significant correlation between the expression of p53 protein in malignant cells and ACD (P = 0.001). All 44 ACD lesions had no staining of c-erbB2, regardless of staining in malignant lesions. The mean Ki-67 labeling index of ACD lesions was low (0.3%), suggesting that ACD had a low proliferative rate. We suggest that ACD is the precancerous breast lesion because of a histologic continuum between ACD and malignancy, and because of p53 protein expression in ACD.