MRCP对黏胆症术前诊断及术式选择的价值  

Value of MRCP in the diagnosis and treatment planning of mucobilia

作　　者：俞顺[1] 严茂林[2] 陈德周[1] 包强[1] 

机构地区：[1]福建医科大学省立临床学院福建省立医院放射科,福建福州350001 [2]福建医科大学省立临床学院福建省立医院肝胆外科,福建福州350001

出　　处：《影像诊断与介入放射学》2015年第5期399-403,共5页Diagnostic Imaging & Interventional Radiology

基　　金：福建省卫生厅青年科研课题资助计划(编号2013-1-3)

摘　　要：目的分析黏胆症的MRCP特征表现,并探讨术前MRCP对黏胆症手术治疗术式选择的价值。方法回顾性分析11例行手术治疗并经病理证实的黏胆症患者的临床资料,结合文献讨论黏胆症MRCP特征表现,结合术中手术记录探讨术前MRCP对黏胆症术式选择的价值。选取同期因病情需要行MRCP检查,手术证实胆石症并胆管炎的患者20例作为对照组,分析两组间肝内胆管不对称性扩张、肝外胆管截断、胆管内病灶呈相对低信号、肝内外胆管结石等征象,并采用Fisher精确概率检验进行比较。结果 11例患者中,男5例,女6例,主要临床表现为波动性黄疸合并反复发热、右上腹痛,8例既往有不同程度胆道手术史。11例黏胆症患者中,肝内胆管不对称性扩张11例、肝外胆管截断0例、胆管内病灶呈相对低信号8例,对照组分别是5、8、3例,差异均有统计学意义(P=0.000、0.045、0.005);11例黏胆症患者中肝内外胆管结石5例,对照组为16例,差异无统计学意义(P=0.117)。黏胆症患者中肝内胆管不对称性扩张、肝外胆管无截断、胆管内病灶呈相对低信号3种征象者共8例,对照组中无一例同时出现3种征象。11例黏胆症患者均接受手术治疗,其中4例患者接受半肝切除(其中2例行胆肠吻合),7例患者行姑息性胆道引流术;11例患者中2例胆管内病灶位于肝左外叶胆管起始部,2例胆管内病灶位于肝左内叶及左外叶胆管分叉部,7例胆管内病灶位于近肝门左肝管起始部。结论黏胆症的MRCP征象主要包括肝内胆管不对称性扩张、肝外胆管无截断、胆管内病灶呈相对低信号。MRCP在黏胆症患者术前诊断中有助于判断胆管内病灶累及的范围和手术方式的选择。Objective To analyze the MRCP features of mucobilia and to assess the value of MRCP in treatment planning of mucobilia..Methods The clinical records and MRCP of 11 patients with pathologically confirmed mucobilia were retrospectively analyzed..MRCP features including asymmetric intra-hepatic bile duct dilatation,.interruption of the extra-hepatic bile duct,hypointense bile duct lesion, intra-and extrahepatic bile duct stone were compared between 11 patients（5 men and 6 women） with mucobilia and 20 patients with cholelithiasis and cholangitisusing the Fisher exact test. Results Fluctuating jaundice with recurrent episodes of fever and right upper quadrant abdominal pain was the most common manifestation of mucobilia. There was history of previous biliary tract surgery in 8 patients. The frequency of asymmetric intra-hepatic bile duct dilatation（11, 5）, interrupted bile duct（0, 8）, and hypointense bile duct lesion（8, 3） in mucobilia and gallstone cholangitis, respectively was significantly different（P=0.000, 0.045, 0.005）. Intra- and extra-hepatic bile duct stone was detected in 8 / 11 patients with mucobilia, not significantly different from the 16 / 20 patients with gallstone cholangitis（P =0.117）. All patients with mucobilia underwent surgery including left hepatectomy for tumors in the proximal left lateral segmental duct（2）, left hepatectomy with extra-hepatic bile duct resection and Roux-en-Y anastomosis for tumors in the bifurcation of left lateral and medial segmental ducts（2）, or palliative biliary drainage for tumors in the left proximal hepatic duct near the porta hepatis（7）. Conclusion The MRCP signs of mucobilia, mainly include asymmetric intra-hepatic bile duct dilatation, no sudden interruption of the extra-hepatic bile duct, signal of Bile duct lesion is relatively low. MRCP might be an effective means for the assessment of lesion extension and is helpful for selection of operation.

关 键 词：磁共振胰胆管成像 黏胆症 胆管肿瘤 

分 类 号：R657.4[医药卫生—外科学]