多排螺旋CT在胆道闭锁后遗症患者术后随访中的应用。

Use of multi-detector row CT for postoperative follow-up of biliary atresia patients with sequelae.

作者信息

Saito Takeshi, Hishiki Tomoro, Terui Keita, Sato Yoshiharu, Mitsunaga Tetsuya, Terui Elena, Nakata Mitsuyuki, Takenouchi Ayako, Matsuura Gen, Komatsu Shugo, Yahata Eriko, Ono Sachie, Sato Hirotaka, Yanagawa Noriyuki, Yoshida Hideo

机构信息

Department of Pediatric Surgery (E6), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, Japan.

出版信息

Pediatr Surg Int. 2011 Mar;27(3):309-14. doi: 10.1007/s00383-010-2743-x. Epub 2010 Oct 10.

DOI:10.1007/s00383-010-2743-x

PMID:20936476

Abstract

BACKGROUND/AIMS: To evaluate the usefulness of multi-detector row computed tomography (MDCT) in the postoperative long-term follow-up of biliary atresia (BA) patients for detection of esophagogastric varices due to portal hypertension and intrahepatic bile duct (IHBD) dilatations. Well-developed esophagogastric varices can cause unexpected life-threatening rupture and contribute to the progression of hepatopulmonary vascular diseases. Dilated IHBDs can trigger cholangitis.

METHODS

After corrective surgery, 29 BA patients (median age 14 years, range 6 months to 27 years) with suspected long-term sequelae underwent 16-slice MDCT. Esophagogastric varices and IHBD dilatations were evaluated using reconstructed images. Detection rates for esophagogastric varices were compared between MDCT and endoscopic findings. Differences in detection rates for IHBD dilatations between MDCT and ultrasonography (US) were also investigated.

RESULTS

Detection rates for esophageal varices did not differ significantly between MDCT and endoscopy, while three cases positive only on MDCT, including one with hepatopulmonary syndrome, showed conspicuous peri-esophageal varices deep in the esophageal wall. MDCT showed a significantly higher detection rate than endoscopy (p = 0.03) for gastric fundal varices. MDCT with the maximum intensity projection disclosed IHBD dilatations in 17 postoperative BA cases, 15 out of which had past history of cholangitis, while US detected them in 6 cases (p = 0.003). In addition, MDCT was more advantageous for detecting IHBD dilatations, particularly those located in the posterior lobe.

CONCLUSIONS

Among postoperative BA patients, compared to endoscopy, MDCT had comparable and superior detection rates for esophageal and gastric fundal varices, respectively. MDCT also precisely demonstrated the location and extent of IHBD dilatations. In long-term follow-up of BA patients, MDCT can help determine follow-up strategies.

摘要

背景/目的：评估多排螺旋计算机断层扫描（MDCT）在胆道闭锁（BA）患者术后长期随访中用于检测门静脉高压所致食管胃静脉曲张及肝内胆管（IHBD）扩张的效用。严重的食管胃静脉曲张可导致危及生命的意外破裂，并促使肝肺血管疾病进展。扩张的IHBD可引发胆管炎。

方法

29例有长期后遗症疑似的BA患者（中位年龄14岁，范围6个月至27岁）在矫正手术后接受了16层MDCT检查。使用重建图像评估食管胃静脉曲张和IHBD扩张情况。比较MDCT与内镜检查结果对食管胃静脉曲张的检出率。还研究了MDCT与超声检查（US）对IHBD扩张检出率的差异。

结果

MDCT与内镜检查对食管静脉曲张的检出率无显著差异，而仅MDCT呈阳性的3例患者，包括1例肝肺综合征患者，显示食管壁深层有明显的食管周围静脉曲张。MDCT对胃底静脉曲张的检出率显著高于内镜检查（p = 0.03）。最大密度投影的MDCT在17例术后BA病例中发现了IHBD扩张，其中15例有胆管炎病史，而US仅在6例中检测到（p = 0.003）。此外，MDCT在检测IHBD扩张方面更具优势，尤其是位于后叶的扩张。