The diagnostic value of 3D spiral CT imaging of cholangiopancreatic ducts on obstructive jaundice

Objective: Computerized tomography (CT) plays an important role in the diagnosis of diseases of biliary tract. Recently, three dimensions (3D) spiral CT imaging has been used in surgical diseases gradually. This study was designed to evaluate the diagnostic value of 3D spiral CT imaging of cholangiopancreatic ducts on obstructive jaundice. Methods: Thirty patients with obstructive jaundice had received B-mode ultrasonography, CT, percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP), and 3D spiral CT imaging of cholangiopancreatic ducts preoperatively. Then the diagnose accordance rate of these examinational methods were compared after operations. Results: The diagnose accordance rate of 3D spiral CT imaging of cholangiopancreatic ducts was higher than those of B-mode ultrasonography, CT, or single PTC or ERCP, which showed clear images of bile duct tree and pathological changes. As to malignant obstructive jaundice, this examinational technique could clearly display the adjacent relationship between tumor and liver tissue, biliary ducts, blood vessels, and intrahepatic metastases. Conclusion: 3D spiral CT imaging of cholangiopancreatic ducts has significant value for obstructive diseases of biliary ducts, which provides effective evidence for the feasibility of tumor-resection and surgical options.

64层螺旋CT胆道三维重建技术协助胆道梗阻的术前评估

目的研究64层CT胆道三维重建(spiral CT cholangiograply,SCTC)在胆道梗阻中的运用价值和优缺点。方法对20例胆道梗阻患者,包括肝门部胆管癌8例,肝内外胆管结石6例,胰头肿物4例,胆管狭窄2例进行SCTC检查,了解胆道树成像的图像质量以及对梗阻性质判断的准确率。结果8例肝门部胆管癌中6例患者得到较完美的胆道树成像,2例患者胆道树部分显影。7例患者的Bismuth-Corlette分型与手术探查一致。4例胰头肿物、2例胆管狭窄、1例胆总管结石的患者术前SCTC均能得到较完美的胆道树成像,能准确提示梗阻的部位和病因。5例复杂的左右肝内胆管结石患者,虽能正确提示肝内外胆管结石的分布和位置,但难以得到较完美的胆道树成像。结论SCTC可作为除复杂左右肝内结石外的胆道梗阻患者的术前评估的常规方法,其运用价值值得进一步的研究和分析。

Caspase-3活性改变对胆道梗阻大鼠中性粒细胞凋亡的影响

目的探讨半胱天冬酶-3(Caspase-3)活性的改变对胆道梗阻(BDO)大鼠外周血中性粒细胞(PMN)凋亡的影响。方法 54只SD大鼠随机分为正常组(A组)、假手术组(B组)和胆总管结扎组(C组),B、C组术后又分为1、3、7、10 d等4个时相,每个时相6只。留取血样标本分离PMN,应用流式细胞仪检测PMN凋亡率,采用荧光分光光度法检测Caspase-3活性。结果 C组PMN凋亡率从术后1 d的54.34±2.35降至10 d的36.01±2.11,低于A组(65.53±2.25)及B组相应时相,P<0.05;Caspase-3活性从术后1 d的52.33±2.35逐步下降至10 d的34.14±3.63,低于A组(60.58±5.35)及B组相应时相,(P<0.05)。结论 BDO大鼠外周血Caspase-3活性降低,可能导致PMN凋亡的减少,在梗阻性黄疸过度炎症反应和脓毒血症的发生、发展中具有重要意义。

三维数字减影技术在恶性肿瘤引起的梗阻性黄疸诊疗中的应用

目的 探讨三维数字减影技术在恶性肿瘤引起的梗阻性黄疸诊疗中的应用.方法 选择晚期恶性肿瘤引起的梗阻性黄疸患者20例,行经超声引导穿刺肝内扩张胆管,注入造影剂,对狭窄病变段进行三维数字减影检查,并将检查得到的三维数字减影图像进行三维成像,观察病变情况.同时随机采集同时间段梗阻性黄疸患者20例未行三维成像的病例,行数据对比分析.结果 三维数字减影可以清晰显示胆管恶性狭窄的位置,精确测量长度,清晰显示狭窄病变段的形态,有助于精确定位及选择合适的治疗方法.三维成像组较未经三维成像组的病例比较,造影剂用量明显减少（P＜0.01）,技术成功时间明显缩短（P＜0.01）,总的曝光剂量明显减少（P＜0.01）.结论 三维数字减影技术对于恶性肿瘤引起的梗阻性黄疸的诊断,病变的精确测量,治疗方法的选择,有着不可替代的作用,并可以明显缩短手术时间及降低造影剂用量和曝光剂量.

一步法超声引导经皮经肝胆道引流术治疗高龄胆道梗阻的探讨

目的：探讨一步法超声引导经皮经肝胆道引流术（ PTCD）治疗高龄（＞60岁）胆道梗阻的有效性、可行性及安全性。方法回顾性地分析147例行一步法PTCD的高龄胆道梗阻患者，分析手术时间、费用、术前及术后血清总胆红素（ STB ）水平、病程及并发症，并比较穿刺成功率和并发症发生率在不同性别、年龄、病程、术前STB、肝内胆管内径及梗阻病因中的差异。结果147例患者穿刺成功127例（86.4％）。穿刺成功率在不同性别及梗阻病因方面差异无统计学意义，而在不同年龄、病程、术前STB、肝内胆管内径方面差异有统计学意义（P＜0．05）。穿刺成功者术后并发症共17例（13.4％），发生率在术前STB水平及恶性梗阻方面差异有统计学意义（P＜0．05）。结论一步法PTCD是治疗高龄胆道梗阻的一项安全、有效的方法，其穿刺成功率与患者病程、胆道梗阻程度及病因有相关性，并发症的发生率与患者术前血清STB水平及梗阻病因密切相关。

Multiplanar reformations and minimum intensity projections using multi-detector row CT for assessing anomalies and disorders of the pancreaticobiliary tree

CT scan is regarded as the imaging modality of choice in patients with pancreaticobiliary ductal abnormalities. However, the axial orientation of the CT images provides only limited anatomical view of pancreaticobiliary ductal abnormalities. The technological advances of multi-de-tector row CT and three-dimensional image processing in workstations allows rapid image acquisition and a short postprocessing time. In particular, multiplanar reforma-tions (MPR) and minimum intensity projections (MinIP) offer rapid and accurate images of the anatomy and ab-normalities of the pancreaticobiliary tree. Moreover, MPR and MinIP help determine the relationship between the pancreaticobiliary ductal anatomy and the surrounding structures. This pictorial review illustrates the wide spec-trum of images obtained by the MPR and MinIP of the anomalies and disorders of the pancreaticobiliary tree.

三维可视化技术在医源性胆管损伤后狭窄术前评估中应用研究

目的探讨三维可视化技术在医源性胆管损伤后狭窄修复手术的术前评估和手术方案选择中的价值。方法回顾性分析上海交通大学医学院附属仁济医院胆胰外科2014年1月至2018年3月接受手术治疗的20例医源性胆管损伤后狭窄病人的临床资料。采用三维可视化工作站对上腹部增强CT进行三维可视化处理和评估。利用增强CT和三维可视化技术评估脉管变异情况、胆管狭窄的位置、肝脏萎缩情况、有无肝门旋转、有无合并肝内胆管结石并测量肝门深度等,比较依据三维可视化评估制定的手术规划与实际施行的手术方式的一致性,随访远期胆管再狭窄情况、肝功能状况与生活质量。结果三维可视化技术评估胆管狭窄Bismuth分型与术中评估完全一致,增强CT评估将2例BismuthⅠ型胆管狭窄误认为BismuthⅡ型,1例Ⅱ型误认为Ⅰ型。三维可视化技术可发现增强CT不能发现的肝动脉和门静脉变异,测量20例病人的肝门深度值范围为(-10.1^+21.1)mm,左肝管横部长度为(15.2±4.6)mm。利用三维可视化技术评估制定的手术规划与实际手术方式完全符合,术中无血管损伤和大出血的发生。结论利用三维可视化技术能提高术前评估的准确性,有利于制定合理的手术路径与方案,提高手术安全性。