儿童先天性胆总管囊肿磁共振胆胰管成像特点及其诊断价值

目的 分析儿童先天性胆总管囊肿(CCC)磁共振胆胰管成像(MRCP)特点及其诊断价值。方法 2020年1月—2023年12月苏州大学附属儿童医院收治CCC儿童90例,纳入同期进行MRI检查正常患儿50例作为对照组,比较CCC组、对照组一般MRI资料,分析CCC分型情况及其MRCP表现,并分析常规MRI、MRCP及DWI检查CCC的表现。结果 CCC组脾脏最大截面面积显著高于对照组,CCC组胆囊长短径比值显著大于对照组,另外CCC组门静脉直径显著宽于对照组,差异均具有统计学意义(P<0.05)。MRCP显示CCC患儿胆总管伴有不同程度囊形、梭形或柱状扩张。Todani分型中以1型例数最多(70例,77.8%),其中又以Ia多见(65例,72.2%),MRCP显示囊肿位于肝门至胰头之间,囊肿直径1.4～7.2 cm,其中合并胆囊结石23例(25.5%)、伴发肝内胆管扩张25例(27.8%)及胰腺炎2例(2.2%),后者表现为胰腺增大伴胰周渗出;各Todani分型中未见V型病例。Kurumi分型以C型为主。在Todani分型中以A、B型多见,共同通道1.3～2.0 cm,另有6例无胰胆管合流异常。常规MRI联合MRCP检出CCC 67例(74.4%),MRI、MRCP联合DWI诊断CCC 83例(92.2%),后者诊断正确率显著高于常规MRI联合MRCP诊断(P<0.05)。结论 MRCP在儿童CCC诊断中的重要价值,特别是在形态学评估、并发症识别及多参数影像联合应用方面具有显著优势。结合DWI的诊断模式可进一步提升影像学检查的准确性,为CCC的临床诊治提供了重要参考。     

先天性胆总管囊肿的影像学检查

目的分析各种影像学检查对先天性胆总管囊肿诊断的准确性和误诊原因。方法近5年来经B超、ERCP、腹部CT、MRCP等影像学检查并手术证实14例先天性胆总管囊肿病人，用回顾性方法将影像学检查结果和误诊原因进行分析。结果各种影像学检查诊断准确率为：B超64．3％；ERCP85．7％；CT92．9％；MRCP100％。误诊原因：B超在囊肿合并结石时易误诊，经验不足也是另一原因；ERCP主要是插管困难造成检查失败，也有因囊肿过大无法完全显影；CT主要是经验不足。结论各种影像学检查都有较高的准确性，也各有优点：B超安全易行、价格低廉；ERCP可以完整地显示囊肿和胆总管的形态及相互问的关系；CT无痛苦、准确性高，对ERCP漏诊的囊肿合并结石病例也能准确诊断，MRCP诊断准确性高，但价格较昂贵。影像学检查除MRCP，都有漏诊的可能。     

成人先天性胆总管囊肿恶变1例

患者女 ,2 8岁 ,上腹痛反复发作 10余年。呈间歇性钝痛 ,无寒热、黄疸病史 ,每年发作数次不等。近 1月来腹痛发作较前频繁 ,呕吐 3次 ,均为胃内容物。查体 :腹部平软 ,剑突下偏右侧轻压痛 ,肝脾不大 ,未触及腹部包块 ,肠鸣音正常。实验室检查 :血、尿、粪常规正常。肝功、胆红素、生化及乙型肝炎五项指标均未查见异常。B超示左、右肝管均扩张 ,测径为 2 .2 cm,肝实质可 ,胆总管全程囊性扩张 (7.0 cm× 3.8cm ) ,壁厚 ,内透声可。结论 :胆总管囊肿。 MR胆总管成像 :胆总管呈囊性扩张 ,最大径 4.6 cm,边界清 ,扩张胆总管内未见异常信号区 ,…     

成人先天性胆总管囊肿诊治体会

1987年1月～1994年3月,我们对6例成人先天性胆总管囊肿病人采用手术治疗,现报告如下。1 临床资料 本组男1例,女5例;年龄17～48岁,平均33岁。腹痛5例,腹部肿块、黄疸各4例,发热、寒战3例。典型三联症者3例。     

先天性胆总管囊肿36例诊治体会

胆总管囊肿是一种先天性疾病,临床较少见,可在各年龄组出现症状。1990年1月至1999年12月,我院共收治该病患者36例,现结合临床资料将其诊治体会介绍如下。1　临床资料本组男8例,女28例,男女之比为1∶3.5;年龄最小7个月,最大47岁,平均17.6岁。临床表现为腹痛27例,黄疸或曾有黄疸病史18例,腹部肿块20例,同时有上述三项表现者6例。术前均行B超检查,确诊35例(97.2%);CT检查24例、PTC2例、磁共振检查3例,均确诊。行X线钡餐胃肠透视2例,均可见胃左移,十二指肠腔扩大呈弧形压迹。均未行胆囊造影或静脉胆道造影。按Alonso-Todani法分型,型31例、…     

成人先天性胆总管囊肿9例的治疗体会

目的 总结成人先天性胆总管囊肿诊治体会.方法 对2002～2009年间收治的9例女性成人先天性胆管囊肿的临床资料进行回顾性分析.结果 7例有胆道炎症表现,5例黄疸,1例有癌变.均为影像学诊断确诊.9例均手术切除囊肿加内引流,均顺利恢复出院.随访2年,无结石复发.癌变患者2年后由于广泛转移死亡.结论 成人先天性胆总管囊肿以囊肿切除并内引流为主,效果满意.     

囊肿切除胆道重建治疗先天性胆总管囊肿

近年来,临床上多主张施行囊肿切除、肝总管—空肠Roux—Y式吻合术治疗先天性胆总管囊肿。我们在施行胆总管横断胆肠吻合时受到启发,将胆总管囊肿横行切断分为两部分,分别切除后再行肝总管空肠吻合。现已采用此术式治疗先天性胆总管囊肿     

先天性胆总管囊肿诊断中介入超声的应用

先天性胆总管囊肿是指胆总管局部的囊性扩张，属先天性发育畸形，由于认识不足，常难以及时确诊。超声检查简便易行，费用低廉，对囊肿诊断敏感性高，超声引导下穿刺造影能迅速明确诊断，可避免延误诊断。现将介入超声在3例最后经手术证实的胆总管囊肿病例中的应用情况报告如下。     

小儿先天性胆总管囊肿腹腔镜手术治疗后并发胆管炎的危险因素分析

目的 探讨小儿先天性胆总管囊肿腹腔镜手术治疗后并发胆管炎的危险因素。方法 纳入湖南省儿童医院2018年6月至2022年6月明确诊断并已行腹腔镜手术治疗的小儿先天性胆总管囊肿85例,根据术后有无并发胆管炎分为并发组(n=14)及未并发组(n=71),对比两组患儿临床特征。logistic回归分析小儿先天性胆总管囊肿腹腔镜手术治疗后并发胆管炎的危险因素。结果 并发组贫血、合并胆道结石、囊肿直径>5 cm、术前白蛋白≤30 g/L、术中出血量>60 mL、术前总胆红素>1.7μmol/L分别为9例、11例、10例、10例、11例、12例,明显高于未并发组的28.17%(20/71)、40.85%(29/71)、30.99%(22/71)、42.25%(30/71)、45.07%(37/71)、35.21%(25/71)(P<0.05)。多因素logistic回归分析证实,贫血、有合并胆道结石、囊肿直径>5 cm、术前白蛋白≤30 g/L、术中出血量>60 mL、术前总胆红素>1.7μmol/L均是小儿先天性胆总管囊肿腹腔镜手术治疗后并发胆管炎的危险因...     

先天性胆总管囊肿的治疗体会

1992～2004年。我们采取胆囊切除 囊肿切除 肝总管空肠Roux—en—Y吻合矩形瓣防反流术治疗先天性胆总管囊肿(CCC)27例，取得了良好效果。现报告如下。     

完全腹腔镜手术治疗成人先天性胆总管囊肿患者疗效及安全性分析*

目的 探究完全腹腔镜手术治疗成人先天性胆总管囊肿的疗效及安全性。方法 回顾性分析2012年2月~2018年5月在我院进行手术治疗的25例先天性胆总管囊肿患者的临床资料,其中接受传统开腹手术治疗者17),采用完全腹腔镜手术治疗者8例。结果 开腹组患者术后首次进食时间、肛门排气时间、排便时间、住院日和术中出血量分别为(5.0±1.7) d、(3.8±1.5)d、(4.7±1.8) d、(9.4±2.3) d和(241.6±15.3)mL,显著长于或多于腔镜组【分别为(3.0±1.1) d、(2.6±0.8) d、(3.1±1.3) d、(6.6±1.2) d和(94.0±9.7)mL,P<0.05】,但腔镜组手术时间为(278.3±60.5)min,显著长于开腹组【(231.7±41.2)min,P<0.05】;治疗后3 d,开腹组患者血清C反应蛋白(CRP)水平为(77.4±6.4)mg/L ,显著高于腔镜组【(30.8±3.5)mg/L,P<0.05】;腔镜组和开腹组手术后并发症发生率分别为37.5%和58.8%,无显著性差异(P>0.05)。结论 完全腹腔镜手术治疗成人先天性胆总管囊肿患者疗效较好,与传统开腹手术比,术中出血量少,术后恢复快,不加重肝功能损伤。     

Mixed type Ⅰ and Ⅱ choledochal cyst in an adult

BACKGROUND:Choledochal cysts are classified into five types based on the location of the cyst.Mixed types of choledochal cysts are extremely rare.Only five cases of mixed typeⅠandⅡcholedochal cysts have been reported, of which one was an adult case.We report a mixed typeⅠ andⅡcholedochal cyst in a 25-year-old man. METHODS:The unusual nature of the choledochal cyst, suspected on magnetic resonance cholangiopancreatography RCP to be typeⅠinitially,was confirmed by laparotomy to be a mixed typeⅠ+Ⅱcyst.Excision...     

Choledochal cyst disease: A review

The authors present a review of the classification, etiology, presentation, treatment and long-term outcome of children and adults with choledochal cyst disease. Unlike children, adults often present with acute biliary tract symptoms or pancreatitis. The treatment of choice remains extrahepatic cyst excision and biliary bypass. This treatment has excellent long-term results that minimize the development of malignancy.     

Narrow portion of the terminal choledochus is a cause of upstream biliary dilatation in patients with anomalous union of the pancreatic and biliary ducts

AIM: To clarify the pathogenesis of biliary dilatation associated with anomalous union of the pancreatic and biliary ducts (AUPBD). METHODS: Direct cholangiopancreatograms of 350 adult patients with or with suspicion of hepatobiliary or pancreatic disorders were reviewed. AUPBD was diagnosed cholangiopancreatographically, when the pancreaticobiliary ductal union was located above the narrow distal segment of the bile duct, which represents the action of the sphincter of Oddi. The narrow portion of the terminal choledochus was defined as symmetrical stricture of the common bile duct just above the pancreaticobiliary ductal union. RESULTS: AUPBD was found in 36 patients. Among ch-olangiopancreatographic features, the narrow portion of the terminal choledochus was the most pathognomonic for AUPBD (accuracy, 98%); it was present in 29 (81%) patients with AUPBD, but was not found in any patients without AUPBD. Among patients with AUPBD, biliary dilatation (>10 mm) was more frequent in those with the narrow portion of the terminal choledochus (23/29) than in those without (2/7; P = 0.018) AUPBD. Among the patients with both AUPBD and the narrow portion of the terminal choledochus, there was a strong negative correlation between the minimum diameter of the narrow portion and the maximum diameter of the choledochus (r = -0.78, P<0.001), suggesting that the degree of biliary narrowing at the narrow portion correlates with that of upstream biliary dilatation. CONCLUSION: The narrow portion of the terminal choledochus, a pathognomonic radiologic feature of AUPBD, may be a cause of biliary dilatation in patients with AUPBD.     

儿童肝母细胞瘤CT影像特征分析

目的 总结肝母细胞瘤（HB）儿童特征和腹部CT的表现。方法 2014年1月~2016年11月我院诊治的HB患儿94例,对全部患儿进行腹部CT扫描,获得影像学资料。结果 本组HB患儿Ⅰ期5例,Ⅱ期 44例,Ⅲ期 38例,Ⅳ期7例;肿瘤体积为29.1~3332.5 cm³,其中Ⅰ期大约为199.9±50.2cm³,Ⅱ期 为429.9±89.4 cm³,Ⅲ期为 419.2±112.3cm³,Ⅳ期为1121.0 ±213.5 cm³;肿瘤位于肝右叶45例（47.8%）、左右叶20例（21.3%）、左叶21例（22.3%）和尾叶8例（8.5%）,肿瘤与肝脏分界清楚73例（77.7%）、分界模糊21例（22.3%）,单发肿瘤81例（86.2%）、多发肿瘤13例（13.8%）,影像学表现为点片状50例（53.2%）、团块状33例（35.1%）和多种形态混合状11例（11.7%）;本组发生肿瘤远处转移38例（40.4%）,其中肺转移18例（47.4%）、骨转移12例（31.6%）、胸膜转移4例（10.5%）和淋巴结转移4例（10.5%）。结论 对HB患儿进行腹部CT检查可了解肿瘤的基本特征,早期发现肿瘤转移,有助于帮助决定选择手术方案。     

Diagnosis and treatment of congenital choledochal cyst: 20 years' experience in China

AIM To summarize the experience of diagnosis andtreatment of congenital choledochal cyst in the past 20years(1980-2000).METHODS The clinical data of 108 patients admitted from1980 to 2000 were analyzed retrospectively.RESULTS Abdominal pain,jaundice and abdominal masswere presented in most child cases.Clinical symptoms inadult cases were non-specific,resulting in delayeddiagnosis frequently.Fifty-seven patients(52.7%)hadcoexistent pancreatiobiliary disease.Carcinoma of thebillary duct occurred in 18 patients(16.6%).Ultrasonicexamination was undertaken in 94 cases,ERCP performedin 46 cases and CT in 71 cases.All of the cases werecorrectly diagnosed before operation.Abnormalpancreatobiliary duct junction was found in 39 patients.Before 1985 the diagnosis and classification of congenitalcholedochal cyst were established by ultrasonographypreoperatively and confirmed during operation,the mainprocedures were internal drainage by cyst enterostomy.After 1985,the diagnosis was established by ERCP andCT,and cystectomy with Roux-en-Y hepaticojejunostomywas the conventional procedures.In 1994,we reported anew and simplified operative procedure in order to reducethe risk of choledochal cyst malignancy.Postoperativecomplication was mainly retrograde infection of biliarytract,which could be controlled by the administration ofantibiotics,there was no perioperative mortality.CONCLUSION The concept in diagnosis and treatment ofcongenital choledochal cyst has obviously been changedgreatly.CT and ERCP were of great help in theclassification of the disease.Currently,cystectomy withRoux-en-Y hepaticojejunostomy is strongly recommendedas the choice for patients with type Ⅰ and type Ⅳ cysts.Piggyback orthotopic liver transplantation is indicated intype Ⅴ cysts(Caroli's disease)with frequently recurrentcholangitis.     

Cholecystoduodenal fistula associated with choledochal cyst: a rare clinical entity

A 61-year-old woman presented with recent history of cholangitis. On evaluation, she was found to have a type I choledochal cyst and a cholecystoduodenal fistula. She underwent excision of the choledochal cyst and disconnection of the fistula. In this case study, we present the diagnostic features and management of choledochal cyst associated with cholecystoduodenal fistula and a literature review of the condition.     

Surgical treatment of type IV choledochal cysts

The benefit of total resection of the dilated bile duct has remained unclear. We describe here our surgical management of 13 patients with type IV choledochal cysts. All six younger patients (25–35 years old) underwent resection of the extrahepatic bile duct (EHBD) and hepaticojejunostomy (HJ), whereas three of the seven older patients (50–68 years old) underwent resection of the EHBD resection and HJ, with the remaining four older patients undergoing total resection of the dilated bile duct and removal of a pancreatobiliary maljunction (PBMJ) in the form of a S4a+S5 hepatectomy (so-called Taj Mahal) and/or pancreas head resection with second portion pancreaticoduodenectomy. No malignancies were detected in the dilated bile duct after resection in the younger patients, but cancer of the gallbladder and/or the dilated bile duct was found in two (27.5%) of the older patients. No cancers were detected during the long-term follow up (1974–2008) in those patients who underwent EHBD resection plus partial hepatectomy, but cancer developed in the remnant duct in one of the older patients who underwent EHBD resection alone. Based on our findings, we recommend that type IV choledochal cysts should be treated by total excision of the dilated bile duct, including the PBMJ, due to its frequent association with malignancy, and to prevent the development of cancer in the remnant duct and improve the long-term survival rate.