CT联合MRCP诊断肝包虫病胆道并发症的价值  

Value of CT combined with MRCP in the diagnosis of hepatic hydatid biliary complications

作　　者：王佳[1] 李辉[1] 马进[2] 牛俊巧[1] 李晓娟 WANG Jia;LI Hui;MA Jin(Radiographic Imaging Center,People's Hostipital of Xin jiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院放射影像中心,乌鲁木齐830001 [2]新疆维吾尔自治区人民医院病理科,乌鲁木齐830001

出　　处：《放射学实践》2020年第9期1132-1137,共6页Radiologic Practice

摘　　要：目的:探讨CT联合磁共振胰胆管成像(MRCP)诊断肝包虫病胆道并发症的价值。方法:回顾性分析经手术、病理证实的54例囊型肝包虫病及16例泡型肝包虫病的胆道并发症的影像表现,并与病理进行对照。结果:54例囊型肝包虫病患者中破入胆道28例(破入胆道组),压迫胆道26例(压迫胆道组)。无症状、腹痛/腹胀、黄疸、发热、合并包虫囊肿感染、急性化脓性胆管炎的发生率在破入胆道组与胆道受压组间差异有统计学意义(P值均<0.05)。破入胆道组与胆道受压组在包虫位置(肝门、非肝门区)、单囊/多子囊型、实变/钙化型、邻近胆道扩张直径、胆管内包虫内容物、胆管壁异常增厚/强化、包虫囊壁异常增厚/强化、肝背景实质异常、舌样/尖角样突起、内外囊分离/内囊塌陷等方面差异有统计学意义(P值均<0.05)。MRCP对囊型肝包虫病患者胆道扩张、胆道内包虫内容物的显示率高,CT对胆管壁、包虫囊壁、肝背景异常及内外囊分离、胆囊受累的显示率高,两者对舌状/尖角样突起、囊内脂肪的显示率一致。泡型肝包虫病侵犯胆道病理显示病灶内胆管闭塞、消失,CT、MRCP示胆道截断/间断显影,远端胆道不同程度扩张;1例重度扩张者病理显示肝内小胆管明显增生合并部分胆管萎缩、胆汁淤积及毛细胆管胆栓;2例病变内液化坏死区与邻近胆管相通,病理显示病变内见褐色胆汁。结论:CT联合MRCP对术前临床准确评估肝包虫病胆道并发症具有重要价值。Objective:To analyze and summarize CT and MRCP manifestations of hepatic hydatid biliary complications.Methods:The imaging features of 54 cases of cystic hydatidosis and 16 cases of cystic hydatidosis confirmed by operation and pathology were analyzed retrospectively.Results:There were significant differences in the incidence of asymptomatic,abdominal pain/distention and jaundice between cystic hydatid and oppressed bile duct(P<0.05);The differences of fever,hydatid cyst infection and acute suppurative cholangitis between two groups were also statistically significant(P<0.05).There were statistically significant differences between two groups in the location(χ^2=23.059,P=0.000),single cyst/multicapse、consolidation/calcification(χ^2=3.996、4.515,P=0.046、0.034),diameter of adjacent bile duct dilatation(t=5.003,P=0.000),content of hydatid cyst in bile duct(χ^2=12.827,P=0.000),abnormal wall of bile duct and hydatid cyst(P=0.024、0.004),abnormal background of liver(χ^2=9.152,P=0.002),tongue like/cusp like protrusion(P=0.024),separation/collapse of cyst wall(χ^2=4.311,P=0.038).The finding rates of MRCP of bile duct dilatation and hydatid content in bile duct were high,the finding rates of CT of bile duct wall,hydatid cyst wall,abnormal liver background,separation of internal and external cysts,gallbladder involvement were high.The finding rates of tongue/cusp like protrusion and fat in cyst were the same for CT and MRCP.The bile duct of hepatic alveolar echinococcus was pathologically occluded and disappeared due to bile duct invaded.However,there were cut off,developed intermittently,and dilated of distal bile duct in different degrees shown in CT and MRCP;For one case of severe dilatation,the intrahepatic small bile duct was obviously hyperplastic with some bile duct atrophy,cholestasis and bile capillary thrombus;In 2 cases,the liquefying necrotic area was connected with the adjacent bile duct,and brown bile was seen in the pathological lesions.Conclusion:There is important diagnostic value for preoperati

关 键 词：肝包虫病 胆道并发症 体层摄影术 X线计算机 磁共振胰胆管成像 

分 类 号：R575.7[医药卫生—消化系统] R814.42[医药卫生—内科学]