螺旋CT及术中胆道造影在先天性胆管扩张症诊疗中的应用
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摘要
目的应用螺旋CT及术中胆道造影指导先天性胆管扩张症的诊断及手术治疗
方法对近5年来我科手术治疗的先天性胆管扩张症65例进行分析、总结。全部病例均行螺旋CT检查和术中胆道造影检查,以辅助指导手术的具体操作。
结果65例中囊肿型42例(其中合并肝内胆管不同程度扩张或狭窄15例),梭状型23例。60例获得清晰的胆道造影图像,胰胆管共同通道过长46例,胰胆管合流角度异常4例,迷走胆管2例,全组患儿术后7～12天治愈出院。
结论通过螺旋CT及术中胆道造影有助于胆管扩张症,特别是对合并了特殊病变患儿的具体手术操作的施行。
Objective To assess the role of the spiral computerized tomography and intraoperativecholangiography for the guidance of diagnosis and operation in Congenital BiliaryDilatation.
Methods Clinical data of 65 cases with Congenital Biliary Dilatation during last 5years were examined by spiral computerized tomography and intraoperativecholangiography to assist specific operations.
Results 65 cases included 42cases of cysts (15 cases with intrahepatic duct varyingdegrees of expansion or narrow among the rest) and 23 cases of clostridium. 60 cases gotclear cholangiography images.46 cases with long pancreaticobiliary common channel. 4cases with anomalous angle junction of pancreaticobiliary duct. 2 cases with variant bileduct. All patients got the curative resections with no major intra-or postoperativecomplications and discharged after 7～12 days.
Conclusions The adoption of spiral CT and intraoperative cholangiographycontributed to the radical operation and the specific purpose of the operation, especiallythe patients with Special lesions.
方法对近5年来我科手术治疗的先天性胆管扩张症65例进行分析、总结。全部病例均行螺旋CT检查和术中胆道造影检查,以辅助指导手术的具体操作。
结果65例中囊肿型42例(其中合并肝内胆管不同程度扩张或狭窄15例),梭状型23例。60例获得清晰的胆道造影图像,胰胆管共同通道过长46例,胰胆管合流角度异常4例,迷走胆管2例,全组患儿术后7～12天治愈出院。
结论通过螺旋CT及术中胆道造影有助于胆管扩张症,特别是对合并了特殊病变患儿的具体手术操作的施行。
Objective To assess the role of the spiral computerized tomography and intraoperativecholangiography for the guidance of diagnosis and operation in Congenital BiliaryDilatation.
Methods Clinical data of 65 cases with Congenital Biliary Dilatation during last 5years were examined by spiral computerized tomography and intraoperativecholangiography to assist specific operations.
Results 65 cases included 42cases of cysts (15 cases with intrahepatic duct varyingdegrees of expansion or narrow among the rest) and 23 cases of clostridium. 60 cases gotclear cholangiography images.46 cases with long pancreaticobiliary common channel. 4cases with anomalous angle junction of pancreaticobiliary duct. 2 cases with variant bileduct. All patients got the curative resections with no major intra-or postoperativecomplications and discharged after 7～12 days.
Conclusions The adoption of spiral CT and intraoperative cholangiographycontributed to the radical operation and the specific purpose of the operation, especiallythe patients with Special lesions.
引文
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[2]钟华,张宗明,朱建平,等.多层螺旋CT三维胆系成像对胆道梗阻的诊断价值[J].世界华人消化杂志,2006,14(35):3430-3432.
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[4]Miyano T,Yamataka A,Li L.Congenital biliary dilatation seminPediatr Surg.2000,9:187-95.
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[8].李龙,王燕霞,王大勇.胰胆合流共同管开口异位与先天性胆总管囊肿形态关系的探讨.中华小儿外科杂志 2002,23:122-123
[9].陈永卫,王燕霞,陈幼容.婴儿胆总管囊肿的临床特点.中华小儿外科杂志 2002,23:461-462
[10]段体德,段文晶,毕品端.提高胆总管囊肿切除、胆肠Roux-Y吻合术疗效的临床经验总结.中国普外基础与临床杂志 2002,9:352-353
[11].董蒨、秋本亮一:胰胆管合流异常症。董蒨主编《小儿肝胆外科学》,人民卫生出版社 2005年1月北京 P409-442
[12].李索林,张道荣,时保军,李振东,陈新英.先天性胆管囊状和梭形扩张的胰胆管合流异常.中华外科杂志2000;38:349-351
[13].石景森,孙学军.胰胆管合流异常与胰胆管疾病的关系.临床外科杂志2007;15:515-516
[14].孟翔凌.重视胰胆管合流异常的处理.临床外科杂志 2007;15:227-229
[15].Ohuchida J,Chijiiwa K,Hiyoshi M,Kobayashi K,Konomi H,Tanaka M.Long-term results of treatment for pancreaticobiliary maljunction without bile duct dilatation.Arch Surg 2006;141:1066-1070
[16].肖现民.不断加深对胰胆管合流异常的认识.肝胆外科杂志2003;11:161-162
[17].林清,陈佛来,李志霞,于则利,张庆余,李洁,夏峰从先天性胆总管囊肿手术历史演变探讨合并胰胆管合流异常的CCC现代外科治疗.中华肝胆外科杂志2000;6:403-406
[18].龚振华,肖现民,周以明,郑珊,胡冰,龚彪.十二指肠乳头位置与胰胆管合流异常.临床儿科杂志2004;22540-542
[19]张克俭,于忠,王远新,董恩钰.先天性胆管囊性扩张合并胰胆管合流异常.中华消化内镜杂志2000;1778-80
[20].韦军民.先天性胆管囊肿的诊治原则与进展.中国医刊2007;42:12-14
[21].邢古生,耿进朝.胰胆管合流异常的病理、临床及影像学诊断.中华放射学杂志2006;40:216-219
[22].季福,施维锦.胰胆管合流异常和胆道疾病.中国实用外科杂志1996;15:626-627
[23].王小林,魏明发.胰胆管合流异常与先天性胆管扩张症胆道癌变.中华小儿外科杂志2003;24:274-276
[24].闫勇,蔡忠红,田伏洲,王雨,杨锁军,陈涛.胰胆管合流异常致胆总管扩张症的诊断治疗.中华肝胆外科杂志2005:11:302-303
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3.丁努,黄晓曦,刘兴.先天性胆管囊性扩张症7例分析.新疆医学.2008.38:146-147.
4.陈炳芳,沈云志,茄佩瑛.先天性胆管囊肿影像学诊断的探讨.中华消化内镜杂志.2006.23(6):447-448.
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13.杨波,王俭.MRI对先天性胆管扩张症的术前定位价值.中国基层医药.2006.13(9):1455-1456.
14.王谦,杜隽,钟玉敏,朱铭.磁共振胰胆道成像在先天性胆管囊性扩张症中的应用.中国医学计算机成像杂志.2003.9.(6):429-431.
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[2]钟华,张宗明,朱建平,等.多层螺旋CT三维胆系成像对胆道梗阻的诊断价值[J].世界华人消化杂志,2006,14(35):3430-3432.
[3]彭卫斌,陈国强,赵亮,等.多层螺旋CT胆道成像技术的临床应用[J].实用放射学杂志,2005,21(11):1 166-1 168.
[4]Miyano T,Yamataka A,Li L.Congenital biliary dilatation seminPediatr Surg.2000,9:187-95.
[5]王慧贞,曲日斌,王维林.先天性胆管扩张症远期疗效随访观察.中华小儿外科杂志2000,21:199-201
[6].韩素芳,彭丽君.儿童胆管扩张症的CT诊断及分型:附97例分析.医学影像学杂志 2001,11:309-311
[7].董蒨,江布先,杨波.先天性胆管扩张症远近端胆管处理的要点及临床意义.中华小儿外科杂志 2001:22:293-295
[8].李龙,王燕霞,王大勇.胰胆合流共同管开口异位与先天性胆总管囊肿形态关系的探讨.中华小儿外科杂志 2002,23:122-123
[9].陈永卫,王燕霞,陈幼容.婴儿胆总管囊肿的临床特点.中华小儿外科杂志 2002,23:461-462
[10]段体德,段文晶,毕品端.提高胆总管囊肿切除、胆肠Roux-Y吻合术疗效的临床经验总结.中国普外基础与临床杂志 2002,9:352-353
[11].董蒨、秋本亮一:胰胆管合流异常症。董蒨主编《小儿肝胆外科学》,人民卫生出版社 2005年1月北京 P409-442
[12].李索林,张道荣,时保军,李振东,陈新英.先天性胆管囊状和梭形扩张的胰胆管合流异常.中华外科杂志2000;38:349-351
[13].石景森,孙学军.胰胆管合流异常与胰胆管疾病的关系.临床外科杂志2007;15:515-516
[14].孟翔凌.重视胰胆管合流异常的处理.临床外科杂志 2007;15:227-229
[15].Ohuchida J,Chijiiwa K,Hiyoshi M,Kobayashi K,Konomi H,Tanaka M.Long-term results of treatment for pancreaticobiliary maljunction without bile duct dilatation.Arch Surg 2006;141:1066-1070
[16].肖现民.不断加深对胰胆管合流异常的认识.肝胆外科杂志2003;11:161-162
[17].林清,陈佛来,李志霞,于则利,张庆余,李洁,夏峰从先天性胆总管囊肿手术历史演变探讨合并胰胆管合流异常的CCC现代外科治疗.中华肝胆外科杂志2000;6:403-406
[18].龚振华,肖现民,周以明,郑珊,胡冰,龚彪.十二指肠乳头位置与胰胆管合流异常.临床儿科杂志2004;22540-542
[19]张克俭,于忠,王远新,董恩钰.先天性胆管囊性扩张合并胰胆管合流异常.中华消化内镜杂志2000;1778-80
[20].韦军民.先天性胆管囊肿的诊治原则与进展.中国医刊2007;42:12-14
[21].邢古生,耿进朝.胰胆管合流异常的病理、临床及影像学诊断.中华放射学杂志2006;40:216-219
[22].季福,施维锦.胰胆管合流异常和胆道疾病.中国实用外科杂志1996;15:626-627
[23].王小林,魏明发.胰胆管合流异常与先天性胆管扩张症胆道癌变.中华小儿外科杂志2003;24:274-276
[24].闫勇,蔡忠红,田伏洲,王雨,杨锁军,陈涛.胰胆管合流异常致胆总管扩张症的诊断治疗.中华肝胆外科杂志2005:11:302-303
1.李正,王慧贞,吉士俊。先天畸形学.北京:人民卫生出版社,1999:694-696.
2.王琼,李园,易珊林.超声诊断先天性胆管囊状扩张症的价值.中国医学影像学杂志.2008.16(3):220-221.
3.丁努,黄晓曦,刘兴.先天性胆管囊性扩张症7例分析.新疆医学.2008.38:146-147.
4.陈炳芳,沈云志,茄佩瑛.先天性胆管囊肿影像学诊断的探讨.中华消化内镜杂志.2006.23(6):447-448.
5.严志汉,闵鹏秋,周翔平.先天性胆管囊肿并胆管癌的CT诊断与术前评估.中华放射学杂志,2002,36:87-88.
6.陈炳芳,沈云志,茹佩瑛.先天性胆管囊肿影像学诊断的评价.中国临床医学影像杂志.2006.17(6):349-350.
7.崔文胜.儿童先天性胆管扩张症CT、MRI诊断.实用放射学杂志.2007.23(1):138-140.
8.洪楠.螺旋CT胆道造影及MRCP对先天性胆总管囊肿的诊断.中国医学影像技术.1998.14(2):120-122.
9.徐元昌,赵吕志,盛金平,熊洪国,关静.螺旋CT在先天性胆管扩张症中的诊断价值.西南军医.2006.8(1):21-22.
10.姜崔元,兰飞跃.先天性胆管囊肿的CT诊断及分型.中外健康文摘.2007.4(10):57-58.
11.Reinhold C,BretPM.Cirrent status ofMR cholangiopancreatograph[J].AJR,1996,166(6):1285-1295.
12.付建设,同志勤,赵京龙,等.磁共振胰胆管成像诊断胆系梗阻性疾病的临床评价[J].实用放射学杂志,2003,19(6):510-513.
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