基于三维磁共振胰胆管造影、胆汁淀粉酶及组织病理学检查的球形与梭形胆总管囊肿的对比分析

Comparative analysis of spherical and fusiform choledochal cyst based on three-dimensional magnetic resonance cholangiopancreatography, biliary amylase, and histopathological examination.

作者信息

Aggerwal Neel, Menon Prema, Rao Katragadda Lakshmi Narasimha, Sodhi Kushaljit S, Kakkar Nandita

机构信息

Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

出版信息

J Indian Assoc Pediatr Surg. 2015 Jul-Sep;20(3):128-32. doi: 10.4103/0971-9261.159021.

DOI:10.4103/0971-9261.159021

PMID:26166983

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4481624/

Abstract

AIMS

The aim was to compare biliary amylase, common channel, and gall bladder/liver histopathology between spherical and fusiform choledochal cysts.

MATERIALS AND METHODS

Children undergoing cyst excision with Roux-en-Y hepatico-jejunostomy over a 17 months period were prospectively studied. The common channel was assessed by three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP).

RESULTS

Among 22 patients (spherical = 10, fusiform = 12), there was a higher incidence of spherical cysts in infants (5/7-71.4%) and fusiform cysts in older children (10/15-66.7%) (P = 0.09). Common channel identified in 14 (64%) cases was long (>10 mm) in 5 (38.2%) (one spherical, four fusiform [P = 0.5]) with associated high biliary amylase levels (>500 IU/L) in four (one spherical, three fusiform) (P = 0.05). Exact point of junction of common bile duct with pancreatic duct was visible with coronal half-Fourier-acquisition single-shot turbo spin-echo and 3D sampling perfection with application with optimize contrast using different flip angle evolution sequence using a reformatted plane of axis, particularly coronal, and coronal oblique orientation. Biliary amylase was raised (>100 IU/L) in 4 (40%) in the spherical group, compared to 8 (67%) in the fusiform group. Mean biliary amylase was similar in gallbladder and cyst in spherical but higher in gallbladder in fusiform cysts. Mean biliary amylase was <500 IU/L in 85.7% infants. Five out of 7 infants had liver fibrosis or cirrhosis on histopathology (P = 0.05). There were no dysplastic changes in the gallbladder epithelium.

CONCLUSION

Three-dimensional MRCP delineated the common channel in two-third cases especially in coronal and coronal oblique orientation. The long common channel may have an etiological role in fusiform cysts. Spherical cysts, especially in infants, have a higher incidence of obstructive cholangiopathy.

摘要

目的

比较球形和梭形胆总管囊肿的胆汁淀粉酶、共同通道及胆囊/肝脏组织病理学情况。

材料与方法

对17个月期间接受囊肿切除并 Roux-en-Y 肝空肠吻合术的儿童进行前瞻性研究。通过三维（3D）磁共振胰胆管造影（MRCP）评估共同通道。

结果

在22例患者中（球形囊肿10例，梭形囊肿12例），婴儿中球形囊肿的发生率较高（5/7 - 71.4%），大龄儿童中梭形囊肿的发生率较高（10/15 - 66.7%）（P = 0.09）。14例（64%）病例中识别出的共同通道较长（>10 mm）的有5例（38.2%）（球形囊肿1例，梭形囊肿4例 [P = 0.5]），其中4例（球形囊肿1例，梭形囊肿3例）伴有胆汁淀粉酶水平升高（>500 IU/L）（P = 0.05）。通过冠状面半傅里叶采集单次激发快速自旋回波序列以及使用不同翻转角演变序列的3D采样完美技术并应用优化对比，利用重新格式化的轴平面，特别是冠状面和冠状斜位方向，可清晰显示胆总管与胰管的精确汇合点。球形囊肿组4例（40%）胆汁淀粉酶升高（>100 IU/L），而梭形囊肿组为8例（67%）。球形囊肿中胆囊和囊肿内的平均胆汁淀粉酶水平相似，但梭形囊肿中胆囊内的平均胆汁淀粉酶水平更高。85.7%的婴儿胆汁淀粉酶平均水平<500 IU/L。7例婴儿中有5例组织病理学显示有肝纤维化或肝硬化（P = 0.05）。胆囊上皮未见发育异常改变。