癌胚抗原鉴别阻塞性黄疸

美国俄亥俄州立大学医学院马丁(Edwa-rd W.Martin Jr.)医师在一次国际学术会议上说,测定癌胚抗原(CEA),能够鉴别阻塞性黄疸中的恶性或良性病变。阻塞性黄疸病人的CEA 水平高于4毫微克/毫升,很可能有恶性病变。此诊断方法不仅经济简便,而且无害,准确.     

良性胆管狭窄内支架引流临床分析

目的 探讨良性胆管狭窄内支架引流的方法和临床价值。方法 22例良性胆管狭窄中，胆管手术后损伤狭窄12例，肝移植术后吻合口狭窄3倒，硬化性胆管炎2例，胆总管下段炎性狭窄3例，慢性胰腺炎致胆总管狭窄2例。所有病人行ERCP，了解胆管狭窄部位、程度，循导丝采用支架置入释放技术置入塑料胆管支架。结果 22例置入单根塑料胆管支架一次性成功，成功率100％，2周内黄疸消失18例，黄疸减轻4例，平均随访6个月，18例狭窄解除取出支架，取出时间为3～12个月，4例处于随访之中。4例出现一过性高淀粉酶血症，无其它与操作有关的并发症。结论 良性胆管狭窄内支架引流安全、有效、成功率高、并发症少，可避免病人手术或再次手术，选择合适的病例，可提高引流效果。     

MRCP结合MR斜冠位T2WI对胆系疾患的应用价值研究

目的:探讨MRCP结合MR斜冠位T2WI对胆系疾患的应用价值。材料与方法:对80例有胆系疾患者行MR常规扫描、MRCP及斜冠位T2WI(向背侧倾斜使与冠状轴呈30°)扫描。结果:在同一投影层面上,斜冠位T2WI显示左右肝管、肝总管及胆总管的显示率优于常规冠状位。MRCP与斜冠位T2WI结合显示管内病灶的大小、边缘、管腔狭窄面形态、狭窄面长度超过1.0cm、胆管走行改变方面优于MRCP结合常规冠状T2WI。结论:MRCP结合斜冠位T2WI对胆道狭窄及梗阻病变的定性及定量分析上具有临床应用价值。     

胆肠吻合对阻塞性黄疸患者生活质量的影响

1．1 对象 2001-01～2004-05我院普外科收住因胆石症和(或)肝内外胆管良性疾病、阻塞性黄疸行胆肠吻合术235例，其中男108例，女127例，年龄19～75岁，平均45．2岁。其中原发性肝内外胆管结石或(并)胆管狭窄169例，先天性胆总管囊肿34例，医源性胆管损伤13例，其他19例。排除标准：胆管癌或胰腺癌症。     

低场磁共振胰胆管水成像55例临床分析

目的评价低场强磁共振（MR）水成像的临床应用价值。方法胆道系统阻塞病变55例使用GESig—naprofile0．2T磁共振设备，先进行腹部常规MR扫描，包括T1WI、T2 WI轴位和T2WI冠状位。磁共振胰胆管造影（MRCP）采用屏气、单次激发快速自旋回波（SSFSE），HTT2WI脉冲序列，二维数据采集成像。检查前禁食水12小时，并训练患者呼吸度。结果55例MRCP图像清楚显示了梗阻部位及狭窄形态，43例与手术病理对照，其中36例符合，准确率为85％。结论MRCP显示胰胆管系统，图像清晰直观，能够多角度、多方位显示肝内外胆管解剖和病变的形态，有助于阻塞性黄疸的定位定性诊断。     

胆肠吻合失误致胆肠吻合口瘘一例报告

胆肠吻合是治疗胆管良性或恶性病变并发阻塞性黄疸的重要方法,术式包括胆总管十二指肠吻合术、胆管空肠Roux-en-Y吻合术和Roux-en-Y吻合基础上发展的抗反流术等多种术式,通过建立通畅的引流多可达到较理想的治疗效果。但如果术中操作失误,将造成严重后果。现将我院收治的1例胆肠吻合失误病例报告如下。1病例资料男,46岁。因反复右上腹疼痛不适3年,加重并皮肤黄染5天,在外院诊断为胆总管结石、胆结石,行胆囊切除、胆总管探查取石、胆总管空肠端侧吻合术。术后病人发热,体温波动在38~39℃之间,并于术后第4天从切口上端流出胆汁样液体。予抗…     

MRC在评价胆系术后胆道并发症的应用价值

目的探讨磁共振胆道造影(MRC)在评价胆系手术后胆道并发症的应用价值。方法24例经临床和手术证实的胆系术后胆道并发症患者,行MR常规扫描同时行磁共振胆道造影检查。采用快速自旋回波重T2WI三维数据采集,最大信号强度投影(MIP)重建。结果胆-肠吻合术后吻合口狭窄4例,MRC表现为截断状、鼠尾状或串珠状狭窄。胆-肠吻合术后吻合口瘘2例,MRC能显示吻合口瘘道。胆囊切除加胆总管切开取石术后胆总管残留结石8例,胆总管狭窄4例,表现为边缘光滑锐利杯口状低信号充盈缺损,以及胆总管局限性、节段性狭窄。腹腔镜胆囊切除术后胆总管狭窄5例,胆瘘1例,表现为胆囊管平面胆总管向心性变窄,以及胆囊管残端过短,往往小于5mm。结论MRC作为一种非侵入性成像技术,能准确评价胆系术后胆道系统的各种并发症,具有很高的临床应用价值。     

阻塞性黄疸的介入治疗

目的研究和讨论阻塞性黄疸的介入治疗方法。方法本组阻塞性黄疸患者46例，结石和恶性肿瘤分别为4例和42例．根据不同情况分别给予外引流、内外引流及胆管内支架治疗。结果对于胆管结石患者经过1wk的引流减黄，为经内镜十二指肠乳头切开取石创造了条件；恶性胆管阻塞者经过介入治疗解决了黄疸问题，增强了食欲，生活质量明显提高。结论本组经过对阻塞性黄疸患者的介入治疗，证明介入治疗阻塞性黄疸为一种积极有效的治疗方法。     

内镜下胆管内支架引流对恶性阻塞性黄疸内毒素血症影响的临床研究

目的：研究探讨内镜下胆管内支架引流术对恶性阻塞性黄疸患者血浆中内毒素含量的影响及临床意义。方法：选择１６例恶性阻塞性黄疸为治疗组，１０例胆囊结石为对照组，观察其术前、后血中内毒素含量、ＴＮＦ及肠道细菌数的变化。结果恶性阻塞性黄疸组术前内毒素水平较正常对照组明显升高，经内镜下胆道内支架引流后，恶性阻塞性黄疸病人的内毒素血症、ＴＮＦ较术前得到有效降低，肠道细菌数减少。ＥＲＢＤ术后无严重并发症发生，减黄满意率８０％。结论：恶性阻塞性黄疸病人存在严重内毒血症，内镜下胆管内引流术能在短时间内有效解除高内毒素血症，是一种创伤小、并发症少、有效的治疗手段。     

超声引导下经皮经肝穿刺胆管置管引流术治疗梗阻性黄疸

目的探讨超声引导下经皮经肝穿刺胆管置管引流术(PTCD)的操作技术及其临床应用价值。方法35例梗阻性黄疸患者,其中28例为恶性阻塞性病变,7例为良性阻塞性病变。在超声引导下行PTCD术39次并常规X线胆道造影。结果穿刺肝左叶胆管11例,右叶胆管28例,穿刺成功率100%,一次置管成功率98.5%,术后一周胆红素平均下降78.6umol/L。结论超声引导下行PTCD是一种治疗梗阻性黄疸的有效方法,具有创伤微小、安全性强、并发症少、可重复操作等优点。     

超声引导下经皮肝胆管穿刺置管引流术治疗恶性阻塞性黄疸的临床价值

目的探讨在超声引导下经皮肝胆管穿刺置管引流术(PTCD)对恶性阻塞性黄疸的临床价值。方法回顾性分析13例恶性肿瘤所致的阻塞性黄疸患者,在普通彩超仪3．5MHz凸阵探头引导下行PTCD术。结果13例患者共行14次PTCD,其中1例左叶置管后滑出改行右前支穿刺置管,1例因肝内胆管内径小于4mm,穿刺失败后选用经皮肝胆囊穿刺置管,手术成功率92．8%(13／14),术后观察黄疸明显消退。结论在超声引导下行PTCD对不宜手术的恶性阻塞性黄疸病人是较好的选择,它具有灵活、简便、创伤小、疗效确切,值得临床推广应用。     

Icteric-type hepatoma: magnetic resonance imaging and magnetic resonance cholangiographic features

Background: We evaluated the imaging features of magnetic resonance imaging (MRI) and magnetic resonance cholangiography (MRC) of icteric-type hepatoma and correlated these with the findings of endoscopic retrograde cholangiography (ERC), percutaneous cholangiography, and surgery. Methods: Thirteen patients with viral hepatitis complicated by cirrhosis of the liver and obstructive jaundice underwent MRC and dynamic MRI. Five patients received percutaneous transhepatic cholangiography and drainage; one of these patients also underwent resection of the left hepatic lobe. Another patient received MRC followed by thrombectomy and T-tube insertion. ERC and endoscopic nasobiliary drainage were performed in another patient for bile diversion. Results: Primary liver tumors and dilatation of biliary system were demonstrated in all patients. No capsule formation could be found in any primary liver tumors. MRI showed the simultaneous presence of an intraluminal tumor in the portal trunk and common hepatic duct in eight patients. Three different MRC features were found: (a) an oval defect in the hilar bile duct(s) with dilated intrahepatic ducts (n= 9), (b) dilated intrahepatic ducts with missing major bile ducts (n= 2), and (c) localized stricture of the hilar bile duct(s) (n= 2). Conclusion: The presence of one or more of the following features in multiplanar MRI and MRC help to identify this rare, specific type of hepatocellular carcinoma: (a) the presence of an intraluminal tumor in both the portal trunk and the common hepatic duct, (b) enhancement of the intraluminal tumor in the common hepatic duct on the arterial phase, (c) type I MRC feature, and (d) hemobilia, blood clot within the gallbladder, and/or type II MRC feature. Received: 12 January 2000/Revision accepted: 12 July 2000     

ERCP后CT诊断梗阻性黄疸病因(附25例分析)

目的 评价ERCP后CT对梗阻性黄疸的诊断价值。方法 25例胆道梗阻性疾病的ERCP后行上腹部螺旋CT容积扫描，在工作站利用软件将图象处理后得到胆道系统MPR和仿真内窥镜图像。结果 25例中，胆管癌2例，砂癌2例，胆总管结石16例，胆总管炎3例，胰头囊性肿瘤1例，胆囊癌侵犯胆总管1例，均经手术或病理证实。结论 ERCP后CT扫描是诊断梗阻性黄疸的一种可靠手段。     

超声对黄疸原因诊断价值初步探讨

目的探讨超声对黄疸原因的诊断价值。方法对116例黄疸患者的声像图改变与最后确诊的黄疸原因进行对照分析。结果116例中,肝细胞性黄疸27例,阻塞性黄疸89例,阻塞性黄疸病例超声定位诊断符合率94.2%,定性诊断符合率87.6%,误诊8例。结论超声检查能够确定是否阻塞性黄疸,准确判断梗阻部位,多数能对梗阻原因做出诊断。提高对胰头部炎性肿块、胆总管炎性狭窄等良性病变声像图表现的认识,有助于提高诊断准确性。     

Color Doppler sonography of bile duct tumor thrombi in hepatocellular carcinoma.

OBJECTIVE: To determine with the use of color Doppler sonography whether bile duct tumor thrombi had detectable vasculature in hepatocellular carcinoma. METHODS: Among 491 patients with tissue-proven hepatocellular carcinoma, 9 (1.8%) had bile duct tumor thrombi. All 9 patients had spectral Doppler sonography guided by color Doppler sonography (3.75-MHz convex probe). RESULTS: All 9 patients had dilated bile ducts with isoechoic thrombi. Eight patients had tumors infiltrating into and obstructing adjacent major bile ducts. The other patient had common hepatic duct tumor emboli that were not adjacent to primary tumors. Color signals were detectable within bile duct tumor thrombi in 7 patients. All of them had pulsatile waveforms on spectral analyses. CONCLUSIONS: Bile duct tumor thrombosis with obstructive jaundice was a rare complication of hepatocellular carcinoma. A detectable color signal with pulsatile waveforms was shown in most cases by color Doppler sonography with spectral analyses.     

ERCP在胆囊切除术后黄疸诊治中的应用

目的：探讨经内镜逆行胆胰管造影（endoscopicretrogradecholangiopancreatograp11y,ERCP）在胆囊切除术后黄疸患者的诊断和治疗中的应用价值。方法：对53例胆囊切除术后不明原因或考虑为外科原因的黄疸患者行ERCP检查,明确黄疸的原因并在内镜下采取相应的治疗措施。对于胆总管结石的患者行乳头括约肌切开（endoscopicsphincterotomy,EST）或乳头球囊扩张（endoscopicpapillaryballoondilation,EPBD）取石,对胆漏和胆道狭窄患者行内镜引流术,对乳头狭窄或括约肌功能异常的患者行EST或EPBD。结果：53例患者均成功行ERCP检查,结果显示胆总管结石38例、胆道损伤8例、乳头狭窄或括约肌功能异常3例、乳头癌1例、肝门胆管癌1例、未见异常2例。经相应治疗后,所有患者均未出现严重并发症。结论：对于胆囊切除术后出现黄疸的患者,ERCP是理想的诊断方法,同时还可以进行内镜下治疗。     

ERCP后CT及MPR诊断肝外梗阻性黄疸病因(附24例分析)

目的:探讨ERCP后加做肝胆胰CT对肝外胆道梗阻病因的诊断价值。材料和方法:24例肝外胆道梗阻病人,经ERCP造影后立即进行CT扫描,应用MPR技术充分显示胆道及其周围情况。结果:24例中,胆管癌5例,胰头癌7例,壶腹癌1例,胆总管下端结石9例,胆总管炎2例,均经手术证实,无假阳性及假阴性。结论:ERCP后加做肝胆胰CT及MPR是诊断肝外梗阻性黄疸的一种可靠手段。     

Clinical value of MRC in the follow-up of liver transplant patients with a choledochojejunostomy

BACKGROUND: We investigated the clinical value of magnetic resonance cholangiography (MRC) in liver transplant patients receiving choledochojejunostomy (CDJ). METHODS: Twenty-five MRCs were performed in 23 initially asymptomatic patients 19 months (mean) after liver transplantation with biliary reconstruction via CDJ. The images were evaluated by consensus (two investigators) for bile duct strictures and dilatations. As a standard of reference, clinical follow-up (including laboratory analysis) was used in 20 cases and direct cholangiography or surgery in three cases. RESULTS: Fourteen pathologic findings were observed in 11 patients (anastomotic strictures in four, left or right bile duct strictures in three, and peripheral segmental dilatations with or without strictures in seven). Patients with pathologic MRC findings had significantly higher levels of alkaline phosphatase (p < 0.05) and more frequently had histories of cholangitis than did patients with normal MRC. Four of six patients with stenoses of the central bile ducts subsequently developed biliary complications requiring treatment (three confirmed by direct cholangiography). In patients with unremarkable bile ducts or only peripherally located changes on MRC, no bile duct complications or relevant changes in the cholestasis parameters occurred during follow-up (mean = 30 months). CONCLUSION: MRC can noninvasively detect pathologic biliary tract changes in liver transplant patients in the asymptomatic stage and provide information for planning invasive therapeutic procedures.     

三维超声成像在胆道梗阻性疾病中的应用

目的：评价三维超声成像在胆道梗阻性疾病中的临床应用价值。方法：29例梗阻性黄疸患者在常规二维超声检查后进行三维超声检查，三维超声重建图像与二维超声图像对比，确定是否可以获得更多的诊断信息。结果：所有患者可以准确地显示梗阻水平，三维最小透明模式可清晰地显示扩张的胆管树结构，包括肝内胆管、肝总管、胆囊以及胆总管。三维最小透明模式与X线模式组合，可显示扩张的胆管与病变组织的空间位置关系。结论：三维超声重建可以更客观地显示胆管解剖，能够提供较二维超声更丰富的信息，对明确诊断及确定治疗方案有重要的临床意义。     

Obstructive jaundice in gastric carcinoma: cause,site, and relationship to the primary lesion

Objective Obstructive jaundice is frequently present in patients with advanced gastric carcinoma. The purpose of this study was to assess the cause and preferential site of bile duct obstruction in patients with gastric carcinoma and to evaluate correlativity of biliary obstruction with the nature of the primary gastric lesion.Methods Cholangiographic findings of 54 patients with metastatic gastric carcinoma presenting with obstructive jaundice were reviewed retrospectively.The level of the bile duct obstruction was divided into four segments: segment 1, from an individual intrahepatic duct to the biliary hilum; segment 2, common hepatic duct (CHD) involvement from the biliary hilum to the level of the cystic duct; segment 3, the proximal half of the common bile duct (CBD); segment 4, the distal half of the CBD. To evaluate the characteristics of the primary gastric lesion, operative records and pathologic findings were reviewed.Results Obstruction sites were segment 1 in eight patients (15%), segment 2 in 25 (46%), segment 3 in 17 (32%), and segment 4 in four (7%). The causes of obstruction were metastatic lymphadenopathy in the hepatoduodenal ligament (50 of 54) and direct invasion of the primary or recurrent tumor (four of 54). The location of the primary gastric lesions was the antrum, antrum and body, and body in 36 (67%), 17 (31%), and 1 (2%), respectively. Borrmann type 3 lesions were present in 72% of cases, and type 2 lesions in the remaining 24%. Histologic type was undifferentiated adenocarcinoma in 91% of patients, and differentiated adenocarcinoma in the remaining. Serosal invasion was shown in 96% of the patients.Conclusion Our results show that the cause of bile duct obstruction in advanced gastric carcinoma is predominantly metastatic lymphadenopathy in the hepatoduodenal ligament, and its preferential site is around the level of the cystic duct. Obstructing lesions showed characteristic cholangiographic findings.