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三维螺旋计算机断层扫描联合静脉胆管造影用于表现为胆囊切除术后症状的硬化性胆管炎

Three-dimensional helical computed tomography with intravenous cholangiography for sclerosing cholangitis manifested as postcholecystectomy symptom.

作者信息

Hase T, Kodama M, Shibata J, Kurumi Y, Kishida A, Kawaguchi A, Ishigami H, Okabe H

机构信息

First Department of Surgery, Shiga University of Medical Science, Japan.

出版信息

J Clin Gastroenterol. 1997 Apr;24(3):169-72. doi: 10.1097/00004836-199704000-00010.

Abstract

A 46-year-old woman who had upper abdominal pain 10 years after cholecystectomy, and who had incidental sclerosing cholangitis (SC), was investigated by three-dimensional helical computed tomographic (3-DHCT) cholangiography with contrast medium, because endoscopic retrograde cholangiography (ERC) was unsuccessful and a second ERC was not permitted by the patient. The cholangiogram demonstrated annular strictures of the bilateral hepatic duct at the confluence of the common hepatic duct, and dilatation of the left intrahepatic biliary duct. Although we could not clarify the cause of the biliary tract deformity at the time of the 3-DHCT, the tentative diagnosis of postcholecystectomy deformity of the biliary tree led to successful treatment by right liver lobectomy and hepaticojejunostomy. Histologic findings were compatible with SC. From this experience and the literature, we suggest that 3-DHCT cholangiography with contrast medium can contribute to the preoperative diagnosis of morphological changes in the biliary tree in patients with postcholecystectomy symptoms.

摘要

一名46岁女性在胆囊切除术后10年出现上腹部疼痛,伴有偶发性硬化性胆管炎(SC)。由于内镜逆行胆管造影(ERC)未成功且患者不允许进行第二次ERC,因此通过三维螺旋计算机断层扫描(3-DHCT)胆管造影术使用造影剂对其进行了检查。胆管造影显示肝总管汇合处双侧肝管环形狭窄,左肝内胆管扩张。尽管在进行3-DHCT时我们无法明确胆道畸形的原因,但胆管树胆囊切除术后畸形的初步诊断使得通过右肝叶切除术和肝空肠吻合术获得了成功治疗。组织学检查结果与SC相符。基于这一经验和文献,我们认为使用造影剂的3-DHCT胆管造影术有助于对有胆囊切除术后症状患者的胆管树形态变化进行术前诊断。

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