头孢曲松钠致成人假性胆结石影像表现与临床分析  

Imaging performance and clinical analysis of ceftriaxone-associated adult biliary pseudolithiasis

作　　者：相龙彬 吕娟娟 张长江 XIANG Longbin;LV Juanjuan;ZHANG Changjiang(Department of Radiology, Weihai Municipal Third Hospital, Weihai 264205, P.R.China)

机构地区：[1]山东省威海市立第三医院放射科,山东威海264205

出　　处：《医学影像学杂志》2020年第4期656-657,665,共3页Journal of Medical Imaging

摘　　要：目的探讨头孢曲松钠致成人假性胆结石的影像学表现及机制、特点。方法回顾性分析32例头孢曲松钠致假性胆结石成人患者临床及影像学资料,结合文献总结此种结石的致病因素、发生机制及特点;入院常规影像学检查32例患者胆囊均无结石征象,治疗期间通过超声检查和/或CT检查确定出现结石,结合用药史做出初步诊断,复查均通过超声检查随访证实。结果32例头孢曲松钠滴注患者中18例于用药后2~7天出现不同程度上腹疼、恶心、呕吐、纳差症状而行影像学检查发现胆囊结石,14例无症状者住院期间例行影像学复查发现胆囊结石。结石多为小颗粒状或泥沙样,CT表现为胆囊低垂部位高密度影,短期复查变化较大;超声检查表现为胆囊内大小不等强回声光团,或疏松泥沙样结石影,后伴较弱声影,且随体位改变形态。停用头孢曲松钠后未经特殊治疗7~30天内影像学检查结石影自行消失。结论头孢曲松钠致成人胆囊假性结石时有发生,了解其发病机制及特点有助于正确诊断。Objective To investigate the imaging performance,mechanism and features of ceftriaxone-associated adult biliary pseudolithiasis.Methods Clinical and imaging data of 32 adult patients with ceftriaxone-associated biliary pseudolithiasis were retrospectively analyzed and pathogenic factors,mechanism and features of this kind of pseudolithiasis were summarized in combination with literatures.No signs of gallstone in 32 patients were found at admission routine examination.During the therapy,gallstones were confirmed by ultrasonography and/or computed tomography,preliminary diagnosis was made combined with medication history,follow-up reviews were all through ultrasound equipment.Results Eighteen of 32 patients showed different levels of abdominal pain,nausea,vomiting and poor appetiteat two to seven days after ceftriaxone therapy,gallstones were confirmed by imaging examination,gallstones at other fourteen asymptomatic patients were found by routine imaging comparison.Most of the gallstones were small granular or sludge-like,presented with high density shadow in the low part of gallbladder at CT examination,which changed greatly in short-term reexamination;Different size of strong echo light massor sludge-like gallstones with weak echo shadow presented in gallbladder at ultrasound,meanwhile,shape of them changed with the body position.Gallstones disappeared spontaneously by image examination at seven to thirty days after the discontinuity of ceftriaxone without other special treatment.Conclusion Ceftriaxone-associated adult biliary pseudolithiasis occurs frequently.Understanding its pathogenesis and featurescan contributes to correct diagnosis.

关 键 词：头孢曲松钠 假性结石 胆结石 体层摄影术 X线计算机 超声检查 

分 类 号：R575.6[医药卫生—消化系统] R445[医药卫生—内科学]