摘要
目的探讨内镜下逆行胰胆管造影(ERCP)与 B 超和计算机断层成像(CT)对华支睾吸虫感染所致胆胰疾病的诊断价值。方法将65例粪便中找到华支睾吸虫卵或胆汁中找到华支睾吸虫成虫或虫卵的梗阻性黄疸患者作为研究对象,对其 B 超、CT 和 ERCP 检查结果进行对比研究。结果 B 超最为简单、方便,主要表现为肝内胆管均匀扩张和肝内胆管壁增厚,回声增强并呈等号状为特征。CT 表现为近肝包膜处有均匀扩张的胆管,呈囊状扩张、胆管壁增厚。十二指肠镜下见约32.3%(21/65)的患者表现为乳头形态异常,开口尖细,黏膜外翻,内陷及僵硬感,插管困难。ERCP 胆道造影表现为细丝形或椭圆形充盈缺损,末稍胆管呈囊状扩张是最有特征性的表现。合并症以胆管结石最多占40%(26/65),胆管癌及十二指肠乳头癌占9.8%(6/65),胰腺炎占1.5%(1/65)。结论对华支睾吸虫感染所致的胆道疾病,三种检查方法的共同特征为弥漫性肝内胆管末端囊性扩张,ERCP 优于体表超声和 CT。内镜下十二指肠乳头括约肌切开术和(或)内镜下鼻胆管引流术结合术后驱虫是该病的首选治疗方法。
Objective To explore the diagnostic value of endoscopic retrograde cholangio-pancreatiography （ERCP）, ultrasonography（US） and CT scanning on cholagio-pancreatic diseases caused by clonorchis sinensis infection. Methods The results of US, CT and ERCP examination in 65 cases of obstructive jaundice caused by clonorchiasis and confirmed by presence of imagoes or eggs in feces or bile juice were analyzed and compared retrospectively. Results US examination was the simplest and most convenient which was characterized by diffuse even dilatation, thickening of walls, strengthened echo with the shape of “equal sign” intrahepatic bile ducts. The characteristic findings of CT included saccular dilatation of bile ducts of the periphery of the liver, thickening of the walls of bile ducts. Under duodenoscopy, 32.3% （21/65） of cases presented as abnormal papilla such as small opening, mucosa outward turned, trapping or stiffness. Aherations in ERCP were characterized by slim or oval filling defect, diffuse saccular dilatation of terminal intrahepatic bile ducts. The most common complications included cholangiolithiasis （40 %, 26/65）, carcinoma of bile duct on papilla （9.8 %, 6/65 ）, and pancreafitis （ 1.5 %, 1/ 65）. Conclusions Three methods were all useful for diagnosis of cholangio-pancreatic diseases caused by clonorchis sinensis infection, which were identically characterized by diffuse saccular dilatation of terminal intrahepatic bile ducts. The gold standard of diagnosis was the presence of imagoes or eggs in bile juice aspirated by the route of ERCP. Endoscopic sphincterectomy with postoperative vermifugal was the first choice of the treatment.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2005年第10期583-585,共3页
Chinese Journal of Digestion
基金
广东省卫生厅基金(A2000700)
关键词
诊断
超声
计算机断层扫描
胆胰疾病
内镜下逆行胰胆管造影
Diagnosis
Ultrasonography
CT scanning
Cholangio-pancreatic diseases
Endoscopic retrograde cholangiopancreatiography
