CT及ERCP对肝吸虫性急性胆道梗阻诊断价值的探讨  

The Values of CT and ERCP in Acute Biliary Tract Obstruction Associated with Clonorchiasis

作　　者：李鹏[1] 赵欣[1] 曾红辉[1] 龙健[1] 张浩[1] 张兴敏[1] 李金茂[1] 潘壬清[1] 陈正云[1] 张键[1] 梁琴珍 张燕玲[1] 杨六成[2] 黄宝裕 李晓林[3] 

机构地区：[1]广东省佛山市顺德区容奇医院放射科,广东佛山528303 [2]广东省佛山市顺德区容奇医院普外科,广东佛山528303 [3]广东省佛山市顺德区容奇医院消化内科,广东佛山528303

出　　处：《中国医师杂志》2005年第9期1195-1196,1213,共3页Journal of Chinese Physician

摘　　要：目的探讨CT及内镜下逆行胰胆管造影(ERCP)对肝吸虫性胆道梗阻的价值。方法回顾手术证实的肝吸虫及其团块引起的急性胆道梗阻47例,其中由内镜下十二指肠乳头括约肌(Oddi’s括约肌)切开术(EST)证实20例,胆总管探查术证实27例,分析其CT及ERCP特点。结果43例患者见不同程度的弥漫性肝内胆管从肝门向被膜方向均匀扩张,39例轻中度肝外胆管扩张,两者扩张不成比例。41例被膜下胆管末端呈囊状或杵状扩张。38例胆囊扩大,9例胆囊内可见软组织团块影。13例见胰腺肿胀,8例见胰管扩张。20例ERCP中16例见肝外胆管轻中度扩张,18例见肝内胆管呈迂曲扩张延伸,末梢呈囊状扩张,可见肝内扩张小胆管突然中断征象,在胆管内可见泥沙样、絮状不规则充盈缺损。3例见肝囊肿与扩张胆管相通。同时20例行EST术,成功解除梗阻。结论急性梗阻性黄疸患者,CT显示肝内胆管均匀弥漫扩张,肝内胆管末端呈囊状改变,伴或不伴肝外胆管扩张,可诊断肝吸虫性梗阻。ERCP可通过抽取胆汁,找到肝吸虫或其虫卵而证实,并可通过EST术解除梗阻。Objective To investigate the values of computed tomography（CT） and endoscopic retrograde cholangiopanc reatography（ERCP） in acute biliary tract obstruction associated with Clonorchiasis. Methods The image features of 47 patients with acute biliary tract obstruction associated with Clonorchiasis proved by operation （27 cases） and ERCP （20 eases） were reviewed retrospectively. Results Fourty-three eases showed equal intrahepatic bile duct diffuse dilatation from perta hepatis to capusle with different levels in CT, and 39 cases showed extrahepafic bile duct dilatation. There was no significant relationship for the extent of intra and extrahepatic bile duct dilatation. It showed the end of intrahepatic bile duct shaped hke a bag in 41 eases, a enlarged gallbladder in 38 eases, and 9 cases with a soft intralumenal masses. There were 13 patients with pancreas swelling and 8 with pancreatic duct dilatation. Of the 20 patients underwent ERCP, eighteen eases showed intrahepatie bile duct diffuse dilatation with the end shaped like a bag, and 16 showed extrahepatie bile duct dilatation. Irregular filling-defect was seen in the common bile duct in 9 cases. The obstruction were relieved after Oddi＇s muscle endoscopic sphincrectomy（EST）. Conclusion The patients with acute obstructive jaundice can be diagnosed as Clonorchiasis, if CT or ERCP showed equal intrahepatic bile duct diffuse dilatation with the end shaped like a bag and with extrahepatic bile duct dilatation, which can be confirmed by the worms and eggs found in the drawing-out bile, and the obstruction can be relived by EST.

关 键 词：肝吸虫 梗阻性黄疸 体层摄影术 X线计算机(CT) ERCP 肝吸虫性胆道梗阻 急性梗阻性黄疸 诊断价值 内镜下逆行胰胆管造影 CT 肝外胆管扩张 

分 类 号：R657.4[医药卫生—外科学] R575[医药卫生—临床医学]