多排螺旋CT后处理技术在胆源性胆囊-十二指肠瘘诊断中的应用

摘要

目的 应用多排螺旋CT(MSCT)后处理技术分析胆源性胆囊-十二指肠瘘的典型影像学特征,探讨其临床价值.方法 回顾性分析2011年1月到2015年7月南京医科大学附属第二医院收治的33例胆源性胆囊-十二指肠瘘患者资料,所有患者均行MSCT平扫及增强检查,用CT后处理技术分析其影像学特征性改变.结果 33例患者胆源性胆囊-十二指肠瘘发生部位:十二指肠球部15例(45.5％),十二指肠球降部3例(9.1％),降部10例(30.3％),水平部5例(15.1％).胆源性胆囊-十二指肠瘘直接征象:瘘道清楚显示,部分呈哑铃型,共有16例显示了瘘道.胆源性胆囊-十二指肠瘘间接征象:2例胆囊显示不清,1例因胆囊癌体积增大,1例因急性胆囊炎胆囊增大;29例胆囊体积明显缩小,体积为6 cm×2 cm～2 cm×1 cm;胆囊壁增厚,平均厚度5 cm;胆囊与十二指肠粘连,分解不清,胆囊周围结构紊乱,可见积液.26例胆道系统积气,其中胆囊积气22例次,胆管积气19例次;胆道系统结石26例次,胆囊结石22例次,胆囊颈部结石6例次,胆总管结石13例次,肝内外胆管结石1例次.十二指肠与胆囊粘连处见憩室样征改变,11例十二指肠出现憩室样征.胆源性胆囊-十二指肠瘘并发症:5例胆石性肠梗阻,2例肝多发脓肿.结论 多层螺旋CT扫描及后处理技术的应用不但可有效显示胆源性胆囊-十二指肠瘘的部位、有无瘘道及形态、胆囊形态、胆囊及胆管积气、结石及周围情况,还可充分显示其并发症,对手术方案的制定有指导意义,具有较高的临床应用价值.%Objective To study the radiologic features and the diagnostic value of multi-slice spiral CT (Multi-slice CT, MSCT) in cholecysto-duodenal fistula.Methods A retrospective analysis was conducted on 33 patients with cholecysto-duodenum fistula.Plain and IV enhanced MSCT were carried out on these patients.Results Of the 33 patients, the fistula was located at the duodenal bulb in 15 patients (45.5％) , the junction of the bulb and the descending part of the duodenum in 3 patients (9.1％) , the horizontal part in 5 patients (15.1％) and the ascending of the duodenum in 10 patients (30.3％).The CT signs of cholecysto-duodenum fistula included in 16 cases.The fistulae were clearly displayed including some fistulae being dumbbell-shaped.The indirect signs of cholecysto-duodenum fistula included in 2 cases the gallbladders were unclearly shown.In 1 case the gallbladder volume increased because of cancer and in another case because of acute cholecystitis.In 29 cases, the gallbladder volume was significantly reduced,with an average volume which ranged from 6 cm × 2 cm to 2 cm × 1 cm, and an average gallbladder wall thickening of 5 cm.There were extensive adhesions between the gallbladder and duodenum with visible effusion.In 26 cases, gas was present in the biliary system with 22 cases showing gallbladder gas, and 19 cases showing biliary pneumatosis.Biliary stones were present in 26 patients (gallbladder stones in 22 cases, gallbladder neck stones in 6 cases, common bile duct stones in 13 cases).At the site between the duodenum and the gallbladder there were radiological changes simulating a diverticulum.In 11 cases the changes were like a duodenal diverticula.The complications of cholecysto-duodenal fistula included 5 cases of gallstone ileus and 2 cases of multiple liver abscesses.Conclusions MSCT is important in depicting presence and location of cholecysto-duodenal fistula.The morphology and shape of the gallbladder, the presence of gas in the biliary system, the presence of stones and the surrounding adhesions could be fully demonstrated by MSCT.MSCT are important for diagnosing cholecysto-duodenal fistula and in the planning of surgery.