胆石症是临床上常见的良性胆道系统疾病。西方国家流行病学调查显示成人胆石症患病率为10%~15%[1],国内报道成人胆囊结石患病率为2.3%~6.5%[2],随着人口老龄化、饮食结构的改变,还在逐年上升。有症状的胆囊结石合并胆总管结石(common bi...胆石症是临床上常见的良性胆道系统疾病。西方国家流行病学调查显示成人胆石症患病率为10%~15%[1],国内报道成人胆囊结石患病率为2.3%~6.5%[2],随着人口老龄化、饮食结构的改变,还在逐年上升。有症状的胆囊结石合并胆总管结石(common bile duct stones,CBDS)患者约占胆囊结石患者的20%[3]。诊断为CBDS患者,建议尽可能取石,对有症状患者益处最大。目前,腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)和内镜下治疗胆总管结石成为主要的治疗方式,LCBDE的发展从经胆总管切开留置T管到经胆总管切开一期缝合,再到经胆囊管切开胆总管探查、一期缝合,目的在于保证治疗效果的同时,提高患者术后的舒适度、降低术后并发症发生率。每一项技术的发展都伴随着科技的进步,腹腔镜及胆道镜的出现使胆总管探查、T管引流这项百余年的经典术式有了质的飞跃。腹腔镜下胆总管探查取石、T管引流术因适应证广泛、安全有效、便于术后再治疗等而被广泛应用,但T管移位、电解质丢失、拔除T管时的并发症等给患者和医者带来诸多困扰。展开更多
胆管导管内乳头状黏液性肿瘤是一类起源于胆管黏膜上皮的肿瘤,临床罕见。其临床表现、实验室检查及常见的影像学检查不具备特异性,给疾病诊断带来了挑战。本文介绍了一例临床表现为胆管炎,常规影像学检查见胆管狭窄及扩张的患者,该患者...胆管导管内乳头状黏液性肿瘤是一类起源于胆管黏膜上皮的肿瘤,临床罕见。其临床表现、实验室检查及常见的影像学检查不具备特异性,给疾病诊断带来了挑战。本文介绍了一例临床表现为胆管炎,常规影像学检查见胆管狭窄及扩张的患者,该患者常规检查均未明确诊断,经内镜逆行胰胆管造影联合胆道镜可见黏液自十二指肠乳头溢出,直视下获取病理组织,最终明确诊断为胆管导管内乳头状黏液性肿瘤。这提示我们内镜逆行胰胆管造影联合胆道镜的价值,为临床诊疗提供一定的参考。Intraductal papillary mucinous neoplasm is a rare type of tumor originating from the epithelium of the bile duct. Its clinical manifestation, laboratory examination and common imaging examination do not have specificity, which result in a challenge to the diagnosis of the disease. This paper reports on a case of a patient with clinical manifestations of cholangitis and conventional imaging studies revealing biliary strictures and dilatations. The patient’s routine examinations failed to establish a definitive diagnosis. However, we employed endoscopic retrograde cholangiopancreatography (ERCP) combined with cholangioscopy to observe mucus spilling from the duodenal papilla and obtained pathological tissue under direct vision. The final diagnosis was intraductal papillary mucinous neoplasm of the bile duct. It implies that ERCP combined with choledochoscopy is valuable for clinical diagnosis and treatment.展开更多
胆总管扩张(Biliary Dilatation, BD)是儿童常见的胆道畸形疾病,约占所有良性胆道疾病的1%。BD在亚洲和女性人群中发病率较高,临床表现主要为腹部包块、腹痛和黄疸。癌变是BD最严重的并发症。影像学检查在BD的诊断中起着重要作用。BD早...胆总管扩张(Biliary Dilatation, BD)是儿童常见的胆道畸形疾病,约占所有良性胆道疾病的1%。BD在亚洲和女性人群中发病率较高,临床表现主要为腹部包块、腹痛和黄疸。癌变是BD最严重的并发症。影像学检查在BD的诊断中起着重要作用。BD早期诊断和治疗非常重要,因为BD是胆管癌的高危因素。外科手术治疗BD的成功率高,并发症率和死亡率低。BD术后患者因胆管吻合口狭窄和癌变的可能性,需要长期的术后实验室和影像学检查随访。Biliary Dilatation (BD) is a common biliary tract malformation disease in children, accounting for about 1% of all benign biliary diseases. BD has a higher incidence in Asian and female populations, with clinical manifestations mainly including abdominal mass, abdominal pain, and jaundice. Carcinoma is the most serious complication of BD. Imaging examinations play an important role in the diagnosis of BD. Early diagnosis and treatment of BD are crucial because BD is a high-risk factor for cholangiocarcinoma. Surgical treatment for BD has a high success rate, with low complication and mortality rates. Postoperative patients with BD need long-term postoperative laboratory and imaging examinations due to the possibility of biliary anastomotic stenosis and carcinogenesis.展开更多
文摘胆石症是临床上常见的良性胆道系统疾病。西方国家流行病学调查显示成人胆石症患病率为10%~15%[1],国内报道成人胆囊结石患病率为2.3%~6.5%[2],随着人口老龄化、饮食结构的改变,还在逐年上升。有症状的胆囊结石合并胆总管结石(common bile duct stones,CBDS)患者约占胆囊结石患者的20%[3]。诊断为CBDS患者,建议尽可能取石,对有症状患者益处最大。目前,腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)和内镜下治疗胆总管结石成为主要的治疗方式,LCBDE的发展从经胆总管切开留置T管到经胆总管切开一期缝合,再到经胆囊管切开胆总管探查、一期缝合,目的在于保证治疗效果的同时,提高患者术后的舒适度、降低术后并发症发生率。每一项技术的发展都伴随着科技的进步,腹腔镜及胆道镜的出现使胆总管探查、T管引流这项百余年的经典术式有了质的飞跃。腹腔镜下胆总管探查取石、T管引流术因适应证广泛、安全有效、便于术后再治疗等而被广泛应用,但T管移位、电解质丢失、拔除T管时的并发症等给患者和医者带来诸多困扰。
文摘胆管导管内乳头状黏液性肿瘤是一类起源于胆管黏膜上皮的肿瘤,临床罕见。其临床表现、实验室检查及常见的影像学检查不具备特异性,给疾病诊断带来了挑战。本文介绍了一例临床表现为胆管炎,常规影像学检查见胆管狭窄及扩张的患者,该患者常规检查均未明确诊断,经内镜逆行胰胆管造影联合胆道镜可见黏液自十二指肠乳头溢出,直视下获取病理组织,最终明确诊断为胆管导管内乳头状黏液性肿瘤。这提示我们内镜逆行胰胆管造影联合胆道镜的价值,为临床诊疗提供一定的参考。Intraductal papillary mucinous neoplasm is a rare type of tumor originating from the epithelium of the bile duct. Its clinical manifestation, laboratory examination and common imaging examination do not have specificity, which result in a challenge to the diagnosis of the disease. This paper reports on a case of a patient with clinical manifestations of cholangitis and conventional imaging studies revealing biliary strictures and dilatations. The patient’s routine examinations failed to establish a definitive diagnosis. However, we employed endoscopic retrograde cholangiopancreatography (ERCP) combined with cholangioscopy to observe mucus spilling from the duodenal papilla and obtained pathological tissue under direct vision. The final diagnosis was intraductal papillary mucinous neoplasm of the bile duct. It implies that ERCP combined with choledochoscopy is valuable for clinical diagnosis and treatment.
文摘胆总管扩张(Biliary Dilatation, BD)是儿童常见的胆道畸形疾病,约占所有良性胆道疾病的1%。BD在亚洲和女性人群中发病率较高,临床表现主要为腹部包块、腹痛和黄疸。癌变是BD最严重的并发症。影像学检查在BD的诊断中起着重要作用。BD早期诊断和治疗非常重要,因为BD是胆管癌的高危因素。外科手术治疗BD的成功率高,并发症率和死亡率低。BD术后患者因胆管吻合口狭窄和癌变的可能性,需要长期的术后实验室和影像学检查随访。Biliary Dilatation (BD) is a common biliary tract malformation disease in children, accounting for about 1% of all benign biliary diseases. BD has a higher incidence in Asian and female populations, with clinical manifestations mainly including abdominal mass, abdominal pain, and jaundice. Carcinoma is the most serious complication of BD. Imaging examinations play an important role in the diagnosis of BD. Early diagnosis and treatment of BD are crucial because BD is a high-risk factor for cholangiocarcinoma. Surgical treatment for BD has a high success rate, with low complication and mortality rates. Postoperative patients with BD need long-term postoperative laboratory and imaging examinations due to the possibility of biliary anastomotic stenosis and carcinogenesis.
