CAJ | 학술논문

目的：分析黏胆症的MRCP特征表现，并探讨术前MRCP对黏胆症手术治疗术式选择的价值。方法回顾性分析11例行手术治疗并经病理证实的黏胆症患者的临床资料，结合文献讨论黏胆症MRCP特征表现，结合术中手术记录探讨术前MRCP对黏胆症术式选择的价值。选取同期因病情需要行MRCP检查，手术证实胆石症并胆管炎的患者20例作为对照组，分析两组间肝内胆管不对称性扩张、肝外胆管截断、胆管内病灶呈相对低信号、肝内外胆管结石等征象，并采用Fisher精确概率检验进行比较。结果11例患者中，男5例，女6例，主要临床表现为波动性黄疸合并反复发热、右上腹痛，8例既往有不同程度胆道手术史。11例黏胆症患者中，肝内胆管不对称性扩张11例、肝外胆管截断0例、胆管内病灶呈相对低信号8例，对照组分别是5、8、3例，差异均有统计学意义（P＝0．000、0．045、0．005）；11例黏胆症患者中肝内外胆管结石5例，对照组为16例，差异无统计学意义（P＝0．117）。黏胆症患者中肝内胆管不对称性扩张、肝外胆管无截断、胆管内病灶呈相对低信号3种征象者共8例，对照组中无一例同时出现3种征象。11例黏胆症患者均接受手术治疗，其中4例患者接受半肝切除（其中2例行胆肠吻合），7例患者行姑息性胆道引流术；11例患者中2例胆管内病灶位于肝左外叶胆管起始部，2例胆管内病灶位于肝左内叶及左外叶胆管分叉部，7例胆管内病灶位于近肝门左肝管起始部。结论黏胆症的MRCP征象主要包括肝内胆管不对称性扩张、肝外胆管无截断、胆管内病灶呈相对低信号。 MRCP在黏胆症患者术前诊断中有助于判断胆管内病灶累及的范围和手术方式的选择。
목적：분석점담증적MRCP특정표현，병탐토술전MRCP대점담증수술치료술식선택적개치。방법회고성분석11례행수술치료병경병리증실적점담증환자적림상자료，결합문헌토론점담증MRCP특정표현，결합술중수술기록탐토술전MRCP대점담증술식선택적개치。선취동기인병정수요행MRCP검사，수술증실담석증병담관염적환자20례작위대조조，분석량조간간내담관불대칭성확장、간외담관절단、담관내병조정상대저신호、간내외담관결석등정상，병채용Fisher정학개솔검험진행비교。결과11례환자중，남5례，녀6례，주요림상표현위파동성황달합병반복발열、우상복통，8례기왕유불동정도담도수술사。11례점담증환자중，간내담관불대칭성확장11례、간외담관절단0례、담관내병조정상대저신호8례，대조조분별시5、8、3례，차이균유통계학의의（P＝0．000、0．045、0．005）；11례점담증환자중간내외담관결석5례，대조조위16례，차이무통계학의의（P＝0．117）。점담증환자중간내담관불대칭성확장、간외담관무절단、담관내병조정상대저신호3충정상자공8례，대조조중무일례동시출현3충정상。11례점담증환자균접수수술치료，기중4례환자접수반간절제（기중2례행담장문합），7례환자행고식성담도인류술；11례환자중2례담관내병조위우간좌외협담관기시부，2례담관내병조위우간좌내협급좌외협담관분차부，7례담관내병조위우근간문좌간관기시부。결론점담증적MRCP정상주요포괄간내담관불대칭성확장、간외담관무절단、담관내병조정상대저신호。 MRCP재점담증환자술전진단중유조우판단담관내병조루급적범위화수술방식적선택。
Objective To analyze the MRCP features of mucobilia and to assess the value of MRCP in treatment planning of mucobilia..Methods The clinical records and MRCP of 11 patients with pathologically confirmed mucobilia were retrospectively analyzed..MRCP features including asymmetric intra-hepatic bile duct dilatation,.interruption of the extra-hepatic bile duct, hypointense bile duct lesion, intra-and extrahepatic bile duct stone were compared between 11 patients (5 men and 6 women) with mucobilia and 20 patients with cholelithiasis and cholangitisusing theFisher exact test. Results Fluctuating jaundice with recurrent episodes of fever and right upper quadrant abdominal pain was the most common manifestation of mucobilia. There was history of previous biliary tract surgery in 8 patients. The frequency of asymmetric intra-hepatic bile duct dilatation (11, 5), interrupted bile duct (0, 8), and hypointense bile duct lesion (8, 3) in mucobilia and gallstone cholangitis, respectively was significantly different (P=0.000, 0.045, 0.005). Intra- and extra-hepatic bile duct stone was detected in 8/11patients with mucobilia, not significantly different from the 16/20 patients with gallstone cholangitis (P=0.117). All patients with mucobilia underwent surgery including left hepatectomy for tumors in the proximal left lateral segmental duct (2), left hepatectomy with extra-hepatic bile duct resection and Roux-en-Y anastomosis for tumors in the bifurcation of left lateral and medial segmental ducts (2), or palliative biliary drainage for tumors in the left proximal hepatic duct near the porta hepatis (7). Conclusion The MRCP signs of mucobilia, mainly include asymmetric intra-hepatic bile duct dilatation, no sudden interruption of the extra-hepatic bile duct, signal of Bile duct lesion is relatively low. MRCP might be an effective means for the assessment of lesion extension and is helpful for selection of operation.