成人胆囊内药源性假性结石CT表现  

CT Manifestations of Adult Drug-induced Pseudolithiasis in the Gallbladder

作　　者：杜宇明 Du Yuming(Department of Imaging,Huainan Sunshine Xinkang Hospital,Huinan,Anhui 232007)

机构地区：[1]淮南阳光新康医院影像科,安徽淮南232007

出　　处：《现代医用影像学》2022年第8期1431-1434,共4页Modern Medical Imageology

摘　　要：目的:探讨成人胆囊内药源性假性高密度结石的CT表现与临床特点。材料与方法:收集2011年10月至2021年5月间住院病人中确认为胆囊内药源性假性结石病例10例,选取标准为:初诊CT片胆囊内无高密度影而随后短期CT复查出现,排除近期使用碘剂造影剂者。6例有超声诊断。本组病人9例使用静脉滴注头孢曲松钠,1例头孢吡腭。查询病历记录药物的用量、时间,记录胆囊内高密度出现的形态、CT值等。胆囊结石患者16例,经手术证实,记录胆囊结石的形态、CT值等。结果:本组10例胆囊内药源性假性结石于用药2-6天后出现,呈高密度影,密度相对均匀,形态规则,以新月形、斑片状为主,位置及形态可以变化,3例胆囊内出现液平面,2例胆总管内亦见高密度影,伴胆管扩张;6例超声表现为胆囊内回声颗粒状改变、强回声光点及光团影。胆囊结石表现为高或低密度影,密度不均,形态呈类圆形、结节状、环形及不规则形,形态一直不变,位置可以移动。结论:胆囊内假性高密度结石多数为偶然发现,仅少数可引起临床症状,需临床干预。其CT表现有别于胆囊结石,区分两者可减少误诊及临床不必要的手术。近5年来,临床使用头孢曲松钠减少,胆囊假性结石发生率降低,但仍需注意其他能从胆汁排泄的头孢类药物亦偶可导致胆囊假性结石的发生。Objective: To analyze CT findings and clinical features of Adult drug-induced pseudolithiasis in the gallbladder(Abbreviated as ADP). Materials and methods:The cases of 10 patients were identified as ADP between October 2011 and May 2021. Selection criteria: First CT examination there was no high density in gallbladder and there was at the second short-term follow-up CT. 6 cases were diagnosed by ultrasound. Intravenous infusion of ceftriaxone sodium was used in 9 cases of patients in this group. One case was used Cefepime. Inquire about the dosage and time of the drug from case history, the morphology and CT value of the ADP was recorded. The control group of cholecystolithiasis had 16 cases were confirmed by operation. The morphology and CT value was recorded. Results:after ceftriaxone sodium treatment, 10 cases ADP in the gallbladder was found in 2-6 days. 2 cases high density also was seen in common bile duct with dilatation, high density is relatively uniform;Form is regular such as crescent shape and patchy shadow etc. Location and morphology can change;3 cases of gallbladder appear level flat. Ultrasound showed granular change, strong echo light spot and light mass in 6 cases. Gallstones show high or low density which is not uniform;the shape was round, nodular, annular and irregular. Shape has not changed, location can move. Conclusion:Most of the ADP was found by chance;A few can cause clinical symptoms which need for clinical intervention. The CT manifestations are different from the gallbladder stones;to distinguish each other can reduce misdiagnosis and unnecessary surgery. In the past 5 years, Reduction in ceftriaxone sodium use, ADP reduced the incidence, but still need to pay attention to other cephalosporins which excretion from bile duct. If it was used in high dose, it also can lead to the occurrence of ADP by chance.

关 键 词：胆囊结石 CT 头孢曲松钠 

分 类 号：R575.62[医药卫生—消化系统] R816.5[医药卫生—内科学]