胆管结石34例的CT与B超诊断对比观察

目的 比较CT与B超对胆管结石的诊断价值.方法 34例临床拟诊胆管结石患者行B超检查,其中23例同期行CT扫描,采用层厚和层距均为5 mm进行常规扫描,对胆总管下端、胆囊颈部结石容易嵌顿部位,或高度怀疑者,先进行层厚和层距均为3 mm薄层扫描,然后进行层厚为3 mm和层距为1 mm的重建.诊断均经手术证实,最后总结CT和B超诊断胆管结石的符合率.结果 34例病人中,32例有胆管结石,2例手术中未见胆管结石.B超诊断结石31例,其中1例为假阳性,2例假阴性,诊断准确率为91%(31/34);CT诊断结石22例,假阴性1例,诊断准确率为96%(22/23).结论 CT是诊断胆管结石的有效手段,其诊断准确性优于B超,尤其是对有合并症者.     

肝内外胆管结石的螺旋CT诊断

探讨肝内外胆管结石螺旋CT表现及诊断价值。对66例肝内外胆管结石的螺旋CT征象进行分析。螺 旋CT诊断肝内外胆管结石的准确率达98．5％;因结石的密度不同可分为3类,即高密度、低密度和混杂密度结石; 肝内胆管扩张包括柱状和囊状扩张,肝外胆道呈圆形扩张;螺旋CT可准确显示结石和诊断其并发症。螺旋CT是 肝内外胆管结石及合并症有效的诊断手段,其中薄层CT及MPR分析对结石更有诊断价值。     

三种影像学方法诊断肝外胆管结石比较研究

目的 探讨采用超声、腹部CT和磁共振胆管成像(MRCP)诊断肝外胆管结石的效能.方法 2017年3月～2019年2月在我院治疗的肝外胆道梗阻性病变患者107例,术前行腹部超声、CT和MRCP检查,以术后病理学检查为金标准,采用ROC曲线分析腹部超声、CT和MRCP诊断肝外胆管结石的效能.结果 本组病例经手术后病理学检查...     

ERCP,B超,CT诊断肝外梗阻性黄疸的价值

肝细胞性黄疸根据B超和实验室检查容易鉴别,而肝外梗阻性黄疸在临床上病因诊断比较困难。尤其胰头癌、十二指肠乳头癌和胆管肿瘤起病隐袭,病人就诊时黄疸较深,往往已届中晚期,病因诊断明确晚,给治疗带来困难。本文对肝外梗阻性黄疸进行B超、CT、ERCP同期检查,探讨其对病因诊断的可比性。     

腹腔镜肝左外叶切除治疗左肝外叶胆管结石的体会

目的探讨腹腔镜肝左外叶切除治疗肝左外叶胆管结石的方法及疗效。方法回顾性分析我科2005年5月-2010年5月共12例患者行腹腔镜肝左外叶切除术治疗肝左外叶胆管结石的临床资料,其中2例并发胆囊结石,术中加行腹腔镜胆囊切除术。结果 12例均在腹腔镜下顺利完成手术,术中出血70 mL～370 mL,术后12例均出现一过性转氨酶升高,3例出现肝残面积液,无残留结石、大出血、胆瘘、腹腔脏器损伤等严重并发症发生。结论腹腔镜肝左外叶切除治疗左肝外叶胆管结石是安全可行的。     

经内镜机械碎石治疗巨大肝外胆管结石的临床应用

经内镜十二指肠乳头切开术（ＥＳＴ），作为非手术治疗胆总管结石的方法，已得到国内外学者的公认。但部分患者因胆石巨大、胆管狭窄等原因而导致ＥＳＴ术后取石失败［１，２］。１９８２年Ｄｅｍｌｉｎｇ首次报道了机械碎石方法的应用，被认为是一种治疗巨大结石最简便易行、安全有效及价格低廉的方法［２－５］。但何为巨大结石，至今国内外仍缺少一种公认的、明确的定义。我们将大于２０ｍｍ以上经ＥＳＴ术后不能直接取出或不能自然排出的胆管结石定为巨大结石。资料与方法一、一般资料：我院自１９９２年１月至１９９７年６月经ＥＲＣＰ…     

肝小脂肪瘤的B超与CT诊断

肝小脂肪瘤的Ｂ超与ＣＴ诊断杨美玉，李治惠，江正辉，何振平第三军医大学附属一院重庆６３００３８肝小脂肪瘤比较少见，多无临床症状，近年来由于影像检查技术的发展，报告病例有增加，本文报道我院近年来经Ｂ超（ｕｓ）与ＣＴ检查，并经手术及病理诊断５例，同时与含脂...     

经内镜及外科手术治疗肝外胆管结石的疗效比较

目的探讨经内镜治疗肝外胆管结石的价值。方法将２００例肝外胆管结石患者分为内镜治疗组（内镜组）及外科手术组（手术组）各１００例,内镜组首先完成经内镜胆胰管造影,诊断确立后即时行十二指肠乳头切开术及胆管取石术;手术组确诊后根据病情选择不同术式,行开腹手术。结果内镜组治愈率为９８％,手术组为９０％（Ｐ＜０．０１）;黄疸消退时间内镜组为（３．０５±０．１２）天,手术组为（７．８３±０．３２）天（Ｐ＜０．０１）;残余结石发生率内镜组为２％,手术组为１０％（Ｐ＜０．０１）;住院时间内镜组为（４．６２±０．１７）天,手术组为（２３．５９±２．７６）天（Ｐ＜０．０１）。结论经内镜治疗肝外胆管结石的疗效明显优于手术疗效,是一种安全可靠的治疗方法。     

肝外胆管结石的治疗

1　胆囊结石1 1　溶解与溶石疗法　口服法 :①鹅脱氧胆酸 (ＣＤＣＡ) :ＣＤ ＣＡ可抑制胆固醇的合成、分泌和吸收诸环节 ,其中以抑制胆固醇分泌最为关键 ,ＣＤＣＡ是通过抑制肝脏胆固醇合成限速酶ＨＭＧ ＣＯＡ还原酶来降低胆固醇合成。用法 :1 5ｍｇ/(ｋｇ ｄ) ,分 3次餐后口服。②熊脱氧胆酸 (ＵＤＣＡ) :ＵＤＣＡ与ＣＤＣＡ相似 ,也是减少胆固醇分泌来降低胆汁胆固醇饱和度 ,但作用更强。ＵＤＣＡ可抑制肝微粒体ＨＭＧ ＣＯＡ活性 ,减少胆固醇合成 ;减少肠道胆固醇的吸收。用法 :81 0ｍｇ/ (ｋｇ ｄ) ,分 3次餐后或晚餐后一次口服。ＣＤ…     

肝外胆管结石对Oddi括约肌功能的影响

目的:探讨肝外胆管结石与O d d i括约肌(sphincter of Oddi,SO)压力的关系.方法:采用前瞻性研究方法,选取2013-01/2014-06南阳医学高等专科学校第一附属医院45例肝外胆管结石患者作为研究对象,根据术中情况,分为松弛组和不松弛组,根据手术次数,分为初发组和复发组.所有患者均采用胆总管切开取石T管引流术,术中进行胆道镜探查并进行SO测压.结果:SO松弛的发生率为40%(18/27).松弛组和不松弛组SO基础压(sphincter of O d d i b a s a l p r e s s u r e,S O B P)、S O峰压(sphincter of Oddi amplitude,SOAP)、SO收缩频率(frequency of sphincter of Oddi phasic contraction,SOF)、SO收缩持续时间(duration of sphincter of Oddi contraction,S O D)分别进行比较,差异有统计学意义(P<0.05).初发组S O松弛的发生率为25%(8/32),复发组为76.92%(10/13),两组进行比较,差异有统计学意义(P<0.05);初发组与复发组胆道镜相关指标进行比较,差异有统计学意义(P<0.05).结论:肝外胆管结石患者SO松弛的发生率较高,多次进行胆道手术可能是SO松弛的重要因素.     

腔隙性脑梗死CT与MR表现对比研究

目的对比腔隙性脑梗死CT与MRI表现并探讨在腔隙性脑梗死诊断中的价值。方法对180例临床疑似腔隙性脑梗死患者在常规头颅CT、MRI的基础上行FLAIR、DWI和MRA检查,根据影像学结果进行对比分析,选择治疗方案。结果①MRI可以确诊疑似病例患者是负腔隙性脑梗死;②FLAIR可以发现早期脑缺血灶;③DWI可显示常规CT和MRI T1W1、T2W1不能显示的病灶（新鲜病灶）。④MRA显示血管闭塞的部位和狭窄程度。结论通过比较影像学早期诊断腔隙性脑梗死,显示梗死灶与靶血管的关系,早期临床体征可提供切实可行的影像学资料。     

Choledocholithiasis: Evaluation with MR Cholangiography

This retrospective study compared imaging results with surgery findings in 26 choledocholithiasis patients who were examined with two-dimensional fast spin-echo (2D-FSE) MR cholangiography and half-Fourier acquisition single-shot turbo spin-echo (HASTE) MR cholangiography. Patients were examined using a 1, 5 T Philips Gyroscan ACS\11 MR scanner and a 1 T Siemens Harmony MR scanner. A total of 21 of the 26 patients with diagnosed choledocholithiasis on imaging were proven to have common bile ducts stones. Two patients had another small stone which was impacted into the Vater and which was not detected with MR cholangiography. One patient with mild dilated common bile duct and pancreatic duct also had a small impacted stone which was not detected by MR cholangiography. One patient had an irregular stone in the hepatic duct, extending partially into the left hepatic duct which was misintepretated as carcinoma. The last patient had a dilated common bile duct due to a small impacted stone which was not detected and biliary sludge which was misintepretated as a stone. The overall sensitivity of MR cholangiography in the detection of common bile duct stones was 80.8%. In conclusion MR cholangiography can rapidly evaluate the common bile duct for stones. The only problem we encountered was in the evaluation of small impacted stones at the Vater. (Dig Endosc 1999; 11: 220–224)     

多层螺旋CT血管成像在脑动脉瘤诊断中的应用

目的探讨多层螺旋CT血管成像在脑动脉瘤诊断中的应用价值。方法对26例颅脑MSCTA患者图像进行分析,评价颅脑MSCTA对脑动脉显示情况及三维重建方法VR、MPR、MIP、SSD对脑动脉瘤及动静脉畸形的显示情况。结果颅脑MSCTA对脑动脉主干及1—3级分支显示率为100％,对大脑中动脉及大脑前动脉4—5级分支的显示率为92．31％-96．15％。VR、MPR是脑动脉瘤的最佳显示方法,综合应用显示更佳。结论MSCTA图像质量更高,可能替代DSA,做为颅脑动脉瘤的最好的影像学诊断方法之一。     

Selective MRCP in the management of suspected common bile duct stones

Background. It is controversial whether selective endoscopic sphincterotomy or routine laparoscopic bile duct exploration is the optimal treatment for choledocholithiasis. Magnetic resonance cholangio-pancreatography (MRCP) is a safe and accurate imaging modality; this study evaluated its use in a clinical algorithm for the management of suspected choledocholithiasis. Patients and methods. Consecutive patients presenting with suspected common bile duct (CBD) stones were managed according to an algorithm involving the selective use of MRCP to identify patients who required endoscopic sphincterotomy and bile duct clearance. Following radiological demonstration of a clear CBD, all patients were considered for cholecystectomy. Results. From 157 consecutive patients, 68 proceeded straight to endoscopic sphincterotomy, which was therapeutic in 59. Of 89 who underwent MRCP, choledocholithiasis was demonstrated in 29; subsequent endoscopic sphincterotomy was therapeutic in 22. MRCP demonstrated a clear CBD in the remaining 60 patients. Seventy-four patients subsequently underwent cholecystectomy, with a conversion rate of 9% and a median postoperative stay of 1 day. There were no instances of post-sphincterotomy pancreatitis or haemorrhage requiring transfusion. Conclusion. An algorithm involving selective MRCP with endoscopic sphincterotomy is a safe, effective means of managing suspected choledocholithiasis, particularly where the expertise, equipment or theatre time for laparoscopic bile duct exploration is not routinely available.     

MRCP在梗阻性黄疸定位与定性诊断中的作用

目的探讨MRCP在梗阻性黄疸病因诊断中的作用。方法回顾性分析有完整临床、病理资料的54例梗阻性黄疸患者MRCP、MRI资料，着重分析MRCP在梗阻定位方面的作用及其形态学特征，并评价其在良恶性病变鉴别诊断中的作用。结果MIP三维重建图像可显示胆管全貌，MRCP对54例胆系梗阻的定位诊断均与手术、内镜所见相符，定位准确率为100％。恶性病变中，9例肝门区胆管癌呈突然截断，梗阻端呈圆钝状或平直状，3例胆总管下段癌呈偏心性、不规则性狭窄；11例胰头癌中8例呈乳头状，3例呈偏心性、不规则性狭窄；6例十二指肠乳头腺癌中5例呈鸟嘴状，1例呈渐行性狭窄。良性病变16例结石梗阻端呈倒杯口状；9例胆总管下段炎性狭窄呈渐行性改变。结论MRCP可明确定位梗阻部位，并初步定性诊断；结合MRI平扫、动态增强资料可显著提高良恶性鉴别诊断正确率。     

B超联合磁共振胰胆管成像对梗阻性黄疸的诊断价值

目的探讨B超与磁共振胰胆管成像检查在梗阻性黄疸诊断中的价值。方法对66例梗阻性黄疸患者进行超声和MRCP检查,并给予手术治疗。结果 B超联合MRCP诊断梗阻性黄疸的正确率为92.4%,其中对13例胰头癌的诊断正确率为100%,13例壶腹部癌的诊断正确率为84.6%,19例胆管癌的诊断正确率为84.2%;对15例胆管结石的诊断正确率为100%,6例良性胆道狭窄为100%。结论 B超联合MRCP检查对诊断梗阻性黄疸有很高的临床应用价值。     

Functional MRCP in pancreatic and periampullary disease

Summary Background. The magnetic resonance (MR) evaluation of the pancreatic and biliary tree has undergone an important evolution because the introduction of the technique of MR cholangiopancreatography (MRCP). Aim. To describe and illustrate the technique of secretin-enhanced MRCP (S-MRCP) and discuss its use in pancreatic and periampullary disease. Methods. Results are based on 6 years experience using MRCP with secretin infusion in hundreds of patients in a tertiary referral center. Results. Secretin improves pancreatic duct and side-branch delineation and the detection of anatomic variants such as pancreas divisum and abnormal common bilio-pancreatic channel. It allows monitoring of pancreatic flow dynamics and evaluation of pancreatic exocrine function that has been previously unavailable. In advanced inflammatory disease, it is useful in monitoring the course of the disease, for planning therapy and for follow-up studies after therapeutic endoscopy. Conclusion. Combining morphology and function into one non-invasive and comprehensive diagnostic modality has expanded the clinical applications of MRCP beyond the diagnostic ERCP that it replaces.     

Detectability of Choledocholithiasis on CT: The Effect of Positive Intraduodenal Enteric Contrast on Portovenous Contrast-enhanced Studies

Background/Aim:

To retrospectively assess the accuracy of intravenous (IV) contrast-enhanced multidetector CT (MDCT) in choledocholithiasis detectability, in the presence and absence of positive intraduodenal contrast.

Patients and Methods:

Over a 3-year period, patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was performed within a week from a portovenous (PV)-enhanced abdominal CT were identified. The final cohort consisted of 48 CT studies in which the entire common bile duct (CBD) length was visualized (19 males, 29 females; mean age, 68 years). We identified two groups according to the absence (n = 31) or presence (n = 17) of positive intraduodenal contrast. CT section thickness ranged from 1.25 to 5 mm. Two radiologists, blinded to clinical information and ERCP results, independently evaluated the CT images. Direct CBD stone visualization was assessed according to previously predefined criteria, correlating with original electronic CT reports and using ERCP findings as the reference standard. A third reader retrospectively reviewed all discordant results. The diagnostic performances of both observers and interobserver agreement were calculated for both groups.

Results:

77%–88% sensitivity, 50%–71% specificity, and 71%–74% accuracy were obtained in the group without positive intraduodenal contrast, versus 50%–80% sensitivity, 57%–71% specificity, and 59%–71% accuracy in the group with positive intraduodenal contrast. With the exception of the positive predictive value (PPV), all diagnostic performance parameters decreased in the positive intraduodenal contrast group, mostly affecting the negative predictive value (NPV) (71%–78% vs 50%–67%).

Conclusion:

PV-enhanced MDCT has moderate diagnostic performance in choledocholithiasis detection. A trend of decreasing accuracy was noted in the presence of positive intraduodenal contrast.     

经内镜逆行胰胆管造影与超声、多排螺旋CT、磁共振胰胆管造影对梗阻性黄疸诊断价值的比较

目的比较内镜下逆行胰胆管造影(ERCP)与超声、多排螺旋CT(MSCT)及磁共振胰胆管造影(MRCP)对梗阻性黄疸的部位及病因诊断的准确率。方法 128例患者行超声、MSCT及ERCP检查,其中35例患者行MRCP检查。结果在梗阻部位的诊断上,四种方法对肝内胆管和胰头部的诊断准确率差异无统计学意义;ERCP对肝外胆管梗阻的诊断准确率与MRCP差异无统计学意义,但显著高于超声和MSCT;在病因诊断上,对于胆系结石、胆管炎和胰头癌的诊断准确率,四种方法差异无统计学意义;MRCP、ERCP和MSCT对于胆管癌诊断准确率均优于超声;此外,ERCP在诊断乳头部肿瘤、十二指肠乳头旁憩室时优于超声和MSCT。结论 ERCP对梗阻性黄疸的部位(尤其是肝外胆管和十二指肠乳头部)及病因(胆管癌、十二指肠乳头部肿瘤)的诊断具有重要价值。