肝内外胆管及胆囊扩张程度和低位梗阻性黄疸病变的相关性  

The correlation between the dilated extent of bile duct and gallbladder and low bile duct obstructive jaundice diseases

作　　者：王中秋[1] 卢光明[1] 黎介寿[2] 李维勤[2] 

机构地区：[1]南京大学医学院南京军区南京总医院医学影像科,210002 [2]南京大学医学院南京军区南京总医院腹部外科研究所,210002

出　　处：《中华放射学杂志》2005年第8期847-851,共5页Chinese Journal of Radiology

摘　　要：目的探讨肝内、外胆管及胆囊扩张程度、形式对低位梗阻性黄疸的诊断价值。方法回顾性分析105例低位阻塞性黄疸患者的CT和内窥镜逆行胰胆管造影(ERCP)的影像资料,将胆系扩张分为下列7种类型:Ⅰ型为肝内、外胆管及胆囊均重度扩张;Ⅱ型为肝外胆管、胆囊重度扩张伴肝内胆管轻度扩张;Ⅲ型为肝内、外胆管重度扩张伴胆囊不扩张或轻、中度扩张;Ⅳ型为肝外胆管重度扩张伴肝内胆管和胆囊不扩张或轻、中度扩张;Ⅴ型为肝内胆管重度扩张伴肝外胆管及胆囊不扩张或轻、中度扩张;Ⅵ型胆囊重度扩张伴肝内、外胆管不扩张或轻、中度扩张;Ⅶ型为肝内、外胆管及胆囊均不扩张或轻、中度扩张。结合手术和病理结果,分析各类型胆系扩展和其低位阻塞性黄疸病变的相关性。结果105例低位阻塞性黄疸中33例为肿瘤性病变,72例为非肿瘤性病变。肿瘤性病变中,Ⅰ型16例,Ⅱ型10例,Ⅲ型4例,Ⅳ型1例,Ⅶ型2例。非肿瘤性病变中,Ⅰ型4例,Ⅱ型4例,Ⅲ型9例,Ⅳ型33例,Ⅴ型2例,Ⅵ型11例,Ⅶ型9例。Ⅰ、Ⅱ型扩张和Ⅲ～Ⅶ型扩张在肿瘤和非肿瘤病变中差异有统计学意义(χ2=47.33,P<0.01)。结论低位阻塞性黄疸病变性质和肝内、外胆管及胆囊扩张程度密切相关:(1)Ⅰ型和Ⅱ型扩张提示绝大多数为肿瘤性病变,少数为嵌顿性结石。(2)Ⅲ～Ⅶ型扩张常为胆管、胆囊结石及炎症。Objective To evaluate the diagnostic value about the dilated extent of bile duct and gallbladder in low biliary obstructive diseases. Methods CT and ERCP findings of 105 patients with low biliary obstructive disease were retrospectively analyzed. The dilated extent of intrahepatic and extra- hepatic bile duct and gallbladder were classified into seven types： Type Ⅰ ： severe dilatation of intrahepatic and extrahepatic bile duct and gallbladder; Type Ⅱ ： severe dilatation of extrahepatic bile duct and gallbladder and slight dilated intrahapetic bile duct ; Type Ⅲ ： severe dilatation of intrahepatic and extrahepatic bile duct without or slight dilatation of gallbladder; Type Ⅳ ： severe extrahepatic bile duct dilatation without or slight dilatation of intrahepatic bile duct and gallbladder; Type Ⅴ ： severe intrahepatic bile duct dilatation without or with slight dilatation of extrahepatic bile duct and gallbladder; Type Ⅵ ： severe gallbladder dilatation without or with slight intrahepatic and extra- hepatic bile duct dilatation; Type Ⅶ： without or with slight dilatation of intrahepatic and extrahepatic bile duct and gallbladder. The biliary system dilated extent of low biliary obstructive disease on CT and ERCP were compared with results of clinical, operation, and pathology. Results Thirty-three cases of tumor and 72 cases of non-tumor were proved by clinical and operation in 105 patients with low biliary obstructive disease. In 33 tumor patients, 16 patients wereidentified as Type Ⅰ, 10 patients Type Ⅱ ,4 patients Type Ⅲ, 1 patient Type Ⅳ, 2 patients Type Ⅶ. In 72 non-tumor patients, 4 patients were identified as Type Ⅰ , 4 patients Type Ⅱ, 9 patients Type Ⅲ,33 patients Type Ⅳ, 2 patients Type Ⅴ, 11 patients Type Ⅵ, 19 patients Type Ⅶ. A large difference between Ⅰ ,Ⅱ type and Ⅲ - Ⅶ type biliary dilatation existed in tumor and non-tumor group（χ^2 = 47.33,P 〈0. 01 ）. Conclusion Low obstructive biliary diseases are closely correlated with the dilated

关 键 词：肝内外胆管 胆囊扩张 低位梗阻性黄疸 嵌顿性结石 手术治疗 

分 类 号：R575[医药卫生—消化系统]