肝门部胆管梗阻，陡病变的MSCT诊断

MSCT Diagnosis of Hepatic Portal Biliary Tract Obstructive Diseases

目的：探讨肝门部不同病变致胆管梗阻的MSCT诊断价值。方法：回顾性分析40例肝门部胆管梗阻患者的临床、MSCT表现，所有病例都进行了MSCT检查并经手术病理证实。结果：40例肝门部胆管梗阻患者中，15例肝门部胆管癌，2例肝门部原发性肝细胞癌，10例肝门部转移癌，8例胆管结石，2例胆囊切除术后胆管损伤，2例先天性胆总管囊肿，1例胆总管炎。27例肝门部胆管恶性梗阻者MSCT表现为肝内胆管呈软藤状重度扩张，肝外胆管中段梗阻，梗阻部胆管呈伴或不伴肿块的截断型或突然狭窄型，肝外胆管壁局限不规则增厚；13例肝门部胆管良性梗阻者MSCT表现为肝内胆管呈枯枝状轻中度扩张，肝内外胆管不一致扩张（内轻外重），肝外胆管远段梗阻，梗阻部胆管呈削尖状狭窄，肝外胆管壁呈弥漫环形增厚。结论：引起肝门部胆管梗阻的疾病多种多样，MSCT对肝门部胆管梗阻性病变的定位及定性诊断具有重要的临床意义。

Objective： To investigate the diagnostic value of MSCT detection on the patients with hepatic portal biliary tract obstructive diseases. Methods： The MSCT manifestations and features of 40 cases with hepatic portal biliary tract obstructive diseases were analyzed retrospectively, all cases had integrated MSCT data and were verified by operation and pathology. Results： Of 40 cases, 15 cases were diagnosed as hepatic portal cholangiocarcinoma,2 cases as hepatic portal primary hepatoma, 10 cases as hepatic portal metastatic carcinoma, 8 cases as Calculus of bile duct, 2 cases as bile duct injury after cholecystectomy, 2 cases as congenital cyst of common bile duct, 1 cases as choledochitis. Mild degree ofintrahepatic bile duct dilatation as a withered tree and disparate dilation （mild in intrahepatie and marked in exprahepatic）were usually found in benign diseases, and marked degree of dilatation as soft rattans was often seen in malignant lesions. Obstruction of the distal portion of the common bile duct was often seen in benign diseases, and malignant obstruction were often found at the middle portion. The gradual tapering in obstruction segment of the bile duct and the diffuse concentric wall thickening of the common bile duct were more often seen in benign cases, whereas dilated extrahepatic bile duct ending abruptly or narrowing sharply with or without a mass and the focal eccentric wall thickening at the obstructed level were more indicative of malignant diseases. Conclusion： The diseases that can cause biliary tract obstruction are multitudinal. MSCT scan is valuable in the location and characterization diagnosis of hepatic portal biliary tract obstructive diseases.