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目的 探讨CT低张增强扫描在胆总管壶腹部梗阻诊断中的应用价值。方法 共47例胆总管壶腹部梗阻患者,其中男28例,女19例,年龄为34~78岁,平均年龄为52 2岁。胆总管扩张分轻度(9mm≤管径<10mm)、中度(10mm≤管径<15mm)及重度(管径≥15mm)。肝内胆管扩张的形态分软藤状、残根状和不典型3类。结果 胆总管轻度扩张17例,其中3例为炎症性狭窄,14例为结石; 中度扩张18例, 15例为结石, 3例为壶腹癌;重度扩张12例,均为壶腹癌。肝内胆管软藤状扩张15例,均为壶腹癌;残根状扩张19例,均为胆总管结石;不典型肝内胆管扩张13例,其中3例为炎症性, 10例为结石。壶腹癌中9例可见“双管征”, 5例可见“双环征”, 3例可见“半月征”,8例可见乳头状软组织结节影。29例结石在梗阻部位可见点状略高密度影。3例炎症性狭窄显示梗阻端胆管逐渐变细。结论 CT低张增强扫描在胆总管壶腹部梗阻的诊断和鉴别诊断中很有价值。
Objective To investigate the value of low-contrast enhanced CT in the diagnosis of abdominal common bile duct obstruction. Methods A total of 47 cases of common bile duct ampullary obstruction patients, including 28 males and 19 females, aged 34 to 78 years, with an average age of 52 2 years old. Common dilatation of the common bile duct (9mm ≤ diameter <10mm), moderate (10mm ≤ diameter <15mm) and severe (diameter ≥ 15mm). Intrahepatic bile duct dilatation was divided into soft rattan, residual root and atypical 3 categories. Results The common bile duct was slightly expanded in 17 cases, of which 3 cases were inflammatory stenosis and 14 cases were stone; moderate expansion in 18 cases, 15 cases of stone, 3 cases of ampullary carcinoma; severe expansion in 12 cases, both of ampullary carcinoma . Intrahepatic biliary soft rattan-like dilatation in 15 cases, are ampullary carcinoma; residual root-like expansion in 19 cases, all common bile duct stones; atypical intrahepatic bile duct dilatation in 13 cases, 3 cases of inflammatory and 10 cases of stones. Ampullary carcinoma in 9 cases can be seen “double sign”, 5 cases can be seen “double ring sign”, 3 cases can be seen “half moon sign”, 8 cases of papillary soft tissue nodules. 29 cases of stones in the obstruction site can be seen slightly high-density point shadow. Three cases of inflammatory stenosis showed a narrowing of the bile duct at the obstruction site. Conclusion CT low-contrast enhancement in the diagnosis of common bile duct ampullary obstruction and differential diagnosis of great value.