目的:探讨MRI不同检查方法对十二指肠乳头旁憩室(periampullary diverticulum,PAD)的诊断价值。方法:应用MRI多序列检查方法诊断PAD23例,并进行分析。结果:T1WI显示为囊状低信号影,与十二指肠相通者1例,其余22例表现为不均匀略低及高低混杂信号,均未明确诊断;横断位压脂T2WI显示含气液平面囊性病灶15例;冠状位FIESTA序列表现为混杂高信号或高信号影15例;呼吸触发3D MRCP表现为高或混杂高信号影16例;冠状位屏气3DCE LAVA动态增强扫描均清晰显示。其中合并胆系结石13例,胆系炎症及感染13例,胰腺炎3例,胆胰管扩张3例,十二指肠炎症3例。结论:MRI能多序列、多方位、直观、无创的清晰显示PAD的部位、大小、范围及与邻近结构的关系,同时显示胆胰疾病形态学改变。故MRI多序列检查非常必要,是PAD诊断及鉴别诊断的重要方法。
ObjectiveTo evaluate efficacy and safety of treatment of Kommerell diverticulum with endovascular technique.MethodThe retrospective analysis was made on the preoperative clinical data, surgical treatment, and postoperative status of patient with Kommerell diverticulum who underwent the endovascular treatment in the Department of Vascular Surgery, Xuanwu Hospital of Capital Medical University.ResultsAccording to the different types and clinical symptoms, the effective endovascular treatment was adopted. The thoracic endovascular aortic repair and coil embolization of Kommerell diverticulum were successfully performed. The postoperative aortic blood flow was unobstructed and the aneurysmal lesion was completely isolated. No endoleakage and intracranial and upper limb ischemia were occurred. The operation time was 55 min and the blood loss was 20 mL. The patient was discharged on day 6 after the operation. No endoleakage, dizziness, and upper limb numbness were found following-up for 12 months.ConclusionFor patient with different types of Kommerell diverticulum and different symptoms, who could be treated by appropriate endovascular treatment and it is effective and safety.
ObjectiveTo discuss the reason and treatment strategy of gallbladder muddy stones after cholecysto-lithotomy. MethodsThe clinical data of 62 patients with gallbladder muddy stones after cholecystolithotomy who were treated in our hospital from December 2008 to December 2014 was analyzed retrospectively. ResultsThere were 43 patients without any symptom and 19 patients with acute cholecystitis in 62 patients. Four patients were diagnosed with septation gallbladder, 6 patients with long and tortuous cystic duct, 3 patients with calculus of cystic duct, 4 patients with common bile duct stones, 39 patients with periampullary diverticula, 18 patients with pancreaticobiliary maljunction, 6 patients with duodenal papilla stenosis, 29 patients with duodenal papillitis, and 3 patients with duodenal papilla adenocarcinoma. Two patients were treated with laparoscopic cholecystectomy (LC), 1 patient with endoscopic sphincterotomy (EST) /endoscopic balloon dilation (EPBD) and LC, 1 patient with percutaneous transhepafic gallbladder drainage (PTGD) and open cholec-ystectomy, 14 patients with PTGD and EST/EPBD, 1 patient with PTGD and hepatocholangioplasty with the use of gallbladder (HG), 34 patients with EST/EPBD, 3 patients with EST/EPBD and endoscopic biliay metal stent drainage (EBMSD), 5 patients with HG, and 1 patient with EST/EPBD and HG. The gallbladder muddy stones disappeared after operations in 55 patients with gallbladder reserved, and gallbladder ejection fraction increased from (42±12) % to (59±16) %. Of the 62 patients, 53 patients were followed up for 6 months to 6 years (the median time was 3.6-year). During the follow-up period, 3 patients were diagnosed with gallbladder stones, 2 patients with common bile duct stones, and 2 patients with intrahepatic and extrahepatic bile duct stones. ConclusionBile efferent tract obstruction is the important reason for the formation of gallbladder stones. HG, EST, and balloon expansion are the efficient methods to resolve the bile efferent tract obstruction.
目的:探讨盲部憩室炎的诊断和手术方式的选择。方法:回顾性分析18例盲部憩室炎的临床资料,包块临床表现、腹部体征、辅助检查、手术方式及随访结果。结果:18例均有右下腹疼痛及右下腹压痛。术前诊断困难,仅通过钡灌肠结肠造影和结肠镜确诊各1例,误诊为急性阑尾炎12例、阑尾周围脓肿1例、回盲部肿瘤3例。憩室单发3例,多发性15例,其中2个憩室9例,3个憩室6例。单纯憩室切除9例,回盲部切除2例;右半结肠切除7例。全组患者均获治愈,无严重并发症发生。结论:盲肠憩室炎的临床特征与急性阑尾炎相似,极易误诊为急性阑尾炎等。术中应注意探查,避免遗漏病变。根据憩室具体情况决定手术方式。
【摘要】目的探讨十二指肠憩室的诊断与治疗。方法对南方医院1982～2002年20年期间收治的110例十二指肠憩室患者的临床资料作回顾性分析。结果憩室分布于十二指肠球部10例，降部77例，水平部15例，升部8例； 憩室合并炎症28例，合并出血14例，合并急、慢性胆胰疾病35例，无合并症33例。手术治疗47例，其中行十二指肠憩室切除术10例，憩室内翻缝合术5例，胃大部切除术13例，胃大部切除+胆肠RouxenY吻合术10例，Oddi氏括约肌成形术2例，胃大部切除+胆囊切除术5例，胰十二指肠切除术2例。术后发生十二指肠瘘1例，手术治疗47例全部治愈，无一例死亡。结论十二指肠憩室以降部多发，无症状者可行保守治疗，若合并炎症、出血、胆胰疾病，则需根据憩室部位合理选择手术方式。