多排螺旋CT表现及胆道三维成像在沿海渔民胆源性肝脓肿诊断和治疗中的应用  

Application of multi-detector spiral CT manifestations and 3D imaging of biliary tract in the diagnosis and treatment of biliary liver abscess among fishermen in coastal areas

作　　者：闫小云 梁萍[1] 陈更瑞[1] 邓琳[1] Yan Xiaoyun;Liang Ping;Chen Gengrui;Deng Lin(Department of Radiology,Beihai People's Hospital,Beihai 536000,China)

机构地区：[1]北海市人民医院放射科,北海536000

出　　处：《中华航海医学与高气压医学杂志》2023年第6期784-788,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

基　　金：广西自然科学基金面上项目(2020GXNSFAA297145)。

摘　　要：目的探讨多排螺旋CT表现和CT胆道三维成像对沿海渔民胆源性肝脓肿临床诊断及治疗的价值。方法回顾性分析2018年1月至2021年12月广西北海市人民医院收治的80例患胆源性肝脓肿的当地渔民的临床资料、CT影像学资料及治疗转归等。结果胆源性肝脓肿以男性居多(51例, 占63.8%), 中老年患者多见(46例, 占57.5%);病灶以单发常见(68例, 占85.0%), 肝右叶发生率最高(52例, 占65.0%);基础疾病较多, 主要为糖尿病(17例, 占21.3%), 其次为痛风(12例, 占15.0%)、慢性乙型肝炎(10例, 占12.5%)、高血压(6例, 占7.5%)等。CT表现特点为环征、簇状征、脓腔内气体征等, 部分患者增强动脉期病灶周围肝实质出现一过性强化, CT胆道三维成像显示邻近肝内胆管扩张, 并可见胆道系统结石或感染等。采用抗生素规范治疗、超声引导下穿刺抽吸脓液、脓肿置管引流、解除胆道梗阻、手术切除等治疗方法, 与治疗前CT影像对比, 所有病例在治疗2~3周内复查CT显示病灶不同程度缩小或消失。结论综合分析临床特征、多排螺旋CT表现及CT三维重建后处理可以明确胆道相关疾病与肝脓肿的关系, 从而提高胆源性肝脓肿的诊断准确率, 为选择临床治疗方案提供依据。Objective To study the clinical value of multi-detector spiral CT manifestations and 3D imaging of biliary tract in the diagnosis and treatment of biliary liver abscess among fishermen in coastal areas.Methods The clinical data,CT images,and treatment outcomes of 80 local fishermen with biliary liver abscess admitted to Beihai People's Hospital of Guangxi between January 2018 and December 2021 were retrospectively analyzed.Results Biliary liver abscess was mostly seen in males(51 cases,63.8%),and among middle-aged and elderly patients(46 cases,57.5%).Single-lesion cases were common(68 cases,85.0%),and the incidence of the lesion involving the right hepatic lobe was the highest(52 cases,65.0%).There were many underlying diseases,mainly diabetes(17 cases,21.2%),followed by gout(12 cases,15.0%),chronic hepatitis B(10 cases,12.5%),hypertension(6 cases,7.5%),etc.CT manifestations were characterized by ring signs,cluster signs,and gas signs in pus cavities.Some patients had transient enhancement of the liver parenchyma around the lesion during the early arterial phase.The 3D imaging of bile ducts showed dilation of adjacent intrahepatic bile ducts,accompanied by gallstones or infection of the biliary tract system.The patients were given standardized antibiotic treatment,ultrasound-guided puncture and aspiration of pus,catheterization and drainage of abscess,relief of biliary duct obstruction,and surgical resection.Compared with the CT images before treatment,the lesions disappeared or were reduced to varying degrees in all cases,according to CT reviewing within 2 to 3 weeks of treatment.Conclusion A comprehensive analysis of clinical features,multi-detector spiral CT manifestations,and 3D reconstruction of CT images can clarify the relationship between biliary tract-related diseases and liver abscess,thereby improving the diagnostic accuracy of biliary liver abscess and facilitating the selection of clinical treatment.

关 键 词：胆源性肝脓肿 多排螺旋CT 胆道 三维成像 

分 类 号：R575.4[医药卫生—消化系统]