影像学检查在先天性胆总管囊肿切除术中的指导意义

摘要

目的 通过对术前超声、核磁共振水成像(MRCP)和术中胆道造影(IOC)的影像学分析,评估影像学检查在胆总管囊肿及合并畸形中的诊断价值.方法 2010年1月至2012年10月我们共收治23例胆总管囊肿患儿,对影像学资料及术中所见进行分析.结果 23例胆总管囊肿患儿中,Ia型 12例;Ic型 3例;IVa型8例.MRCP及IOC对胆总管囊肿形态显示清晰,MRCP对近端胆管扩张及狭窄显示清楚,而IOC可因图像的重叠造成病变遗漏.MRCP显示胰胆管合流异常10例(43.5%),IOC显示胰胆管合流异常19例(82.6%).IOC对胰胆合流的显影率高,明显优于MRCP.胆管狭窄在术中得到证实,对狭窄胆管均行胆管成形,远端胆管在靠近汇合处离断,术中无胰管损伤.结论 MRCP和IOC选择性联合应用,对手术有重要的指导作用.%Objetive To evaluate the significance of imaging by magnetic resonance cholangio-pancre-atography( MRCP) and by intraoperative cholangiography (IOC ) in congenital choledochal cyst. Methods A retrospective study was made on 23 patients, of 2010-2012, with choledochal cysts who were examined by MRCP and IOC accordingly. Results According to Todani' s classification,there were type Ia 12 cases, type Ic 3 cases, and type IVa 8 Cases. The shape of the cyst and the range of the biliary dilation were well illustrated in both MRCP and IOC. The 3D image of MRCP might show the different aspects,so that the stricture could be easily located. The image of the cyst was delineated clearly in IOC,but sometimes, misled by possible overlapping and resulted in oversight. MRCP showed pancreatico biliary maljunction (PBM) in 10 cases (43.5% ) , while IOC showed PBM in 19 cases (82. 6% ). The detectability of PBM by IOC was much better than MRCP. All positive findings of biliary strictures were proved and corrected during operation before anastomosis with jejunum. Under the guidence of imaging, the distal end of the cyst was cut close by the pancreatico biliary junction and no injury of pancreatic duct occurred in this study. Conclusion MRCP combined with IOC selectively is,although some invasive,significant in raising the accuracy and confidence in the operation of choledochal cyst.