摘要
目的 探讨MRI检查在胆囊切除术后胆系并发症的诊断和选择治疗方案中的作用。方法 收集因“胆石症或慢性胆囊炎”行胆囊切除术后临床出现胆系并发症、MRI检查发现异常的病例共 5 0例。全部病例均按标准的成像参数 ,行MRIT1WI横断面平扫和增强扫描、冠状面增强扫描 ,T2WI横断面平扫 ,Truefisp冠状面平扫和MRCP。结果 胆囊切除术后胆系常见并发症包括 :胆系结石 2 2例 ,继发性胆管炎和胆源性肝脓肿 15例 ,肝总管与胆总管汇合处狭窄、中断分别为 6例及 3例 ,胆系肿瘤 9例 ;其它并发症有胆汁漏、胆汁瘤、急性胰腺炎、残株胆囊炎等。结论 MRI检查在肿囊切除术后并发症的诊断中可发挥重要作用 ,可准确判断引起胆系并发症的原因 ,胆道梗阻的部位、程度及原因 ,评估胆系肿瘤累及的范围及可切除性 ,因此 ,有助于明确诊断和选择治疗方案。此外 ,在腹腔镜胆囊切除术前 ,应对胆系和胰腺进行全面、详细的影像学评价 。
Objective To investigate the value of magnetic resonance (MR) imaging in the assessment of bile duct complications after cholecystectomy. Methods Fifty patients of having bile duct complications after cholecystectomy underwent MR imaging and had some positive manifestations. The indication for cholecystectomy was symptometic cholelithiasis in all cases. MR imaging was performed with a 1.5 T clinical imager including all of the sequences of: ①T1 weighted imaging (T1WI) was performed in transverse and coronal plane before and after gadolinium enhanced. ②T2 weighted imaging (T2WI) was performed in transverse plane. ③A true fast imaging with steady state precession sequence (True fisp) was performed in coronal plane. ④MR cholangiopancreatography was also obtained. Results The bile duct complications after cholecystectomy including: 22 cases of cholelithiasis, 15 cases of chronic cholangitis with or without bile duct abscess. Bile duct strictures or abruption at the confluence of hepatic and common bile duct in 6 and 3 cases respectively. Tumors of bile duct or pancreas in 9 cases. The other complications after cholecystectomy including bile leak with choleperitonitis and/or biloma and acute pancreatitis.Conclusion MR imaging was a valuable method for the assessment of bile duct complications after cholecystectomy. MR imaging could assess the etiology of bile duct complications. If there were bile duct obstruction, MR imaging could assess the location and the severe of obstruction. For bile duct or pancreatic tumors, MR imaging could assess the areas of tumor infiltration and resection and was helpful to select treatment methods. Before lapatoscopic cholecystectomy, the overall and careful imaging assessment for bile duct and gallbladder and its adjacent hepatic tissue and pancreas so to avoid missing the relative tumors.
出处
《中国普外基础与临床杂志》
CAS
2004年第4期364-368,共5页
Chinese Journal of Bases and Clinics In General Surgery
关键词
MRI
胆囊切除术
术后并发症
磁共振成像
继发性胆管炎
胆结石
Cholecystectomy Complication Magnetic resonance imaging Magnetic resonance cholangiopancreatography
