肝囊型包虫合并胆瘘的临床及影像资料分析

发布时间：2017-12-31 08:32

本文关键词：肝囊型包虫合并胆瘘的临床及影像资料分析　出处：《青海大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:回顾性分析肝囊型包虫合并胆瘘的临床及影像学资料,探讨肝囊型包虫病发生胆瘘的危险因素,并为肝囊型包虫合并胆瘘提供一定的影像学依据。方法:收集2013年-2016年在我院行肝囊型包虫手术治疗的病例,共176例,术前均行CT检查,部分行MRI检查,了解患者临床表现及相关实验室检查,根据手术结果有无合并胆瘘将病例分为有胆瘘组68例和无胆瘘组108例,分析胆瘘组的影像学资料,为胆瘘的术前诊断提供影像学依据。统计可能导致胆瘘的7个危险因素,用单因素和多因素方差分析确定胆瘘发生的独立危险因素。结果:176例病例中,共68例经手术确诊合并胆瘘,其中术前CT提示胆瘘16例,不同程度显示胆管与病灶之间直接交通或病灶远端胆管扩张、走行迂曲。47例行MRI检查的胆瘘病例中,提示胆瘘20例,CT未提示胆瘘的4例患者均行MRI,于常规序列未发现明显的肝内胆管扩张,而MRCP均显示病灶周边细小胆管局部管壁未显影。反观术前未诊断出胆瘘的病例影像资料,发现常规影像学检查尚不能找到支持胆瘘的相关特征。对病灶囊液进行弥散定量测定;有胆瘘组及无胆瘘组ADC值分别为(2.89士0.97)×10-3mm2/s、(3.11士0.83)×10-3mm2/s,差异有统计学意义。对可能导致胆瘘的因素进行方差分析得出::有包虫病手术史、囊肿大小、位置3组数据有统计学差别,性别、年龄、肝炎病史、分型不是胆瘘发生的有害要素。进一步分析确定并发胆瘘的独立有害要素。结果显示囊肿总径线越大、囊肿位于肝脏中央段是容易导致肝囊型包虫胆瘘的发生的独立有害要素。包虫囊肿总径线每增加10厘米,胆瘘的可能增进6.395倍,囊肿位于肝内中央段比位于外周段合并胆瘘的机率增进3.965倍。结论:胆瘘术前诊断率低,常规影像学检查结合扩散加权成像有利于辅助诊断。MRCP能多方位、多角度、清楚的显示包虫囊肿瘘入胆道的情况,观察受累胆道管腔的程度和范围。胆瘘的发生有其独立的危险因素,了解这些危险因素有助于临床治疗的决策,一定程度上减少了胆瘘并发症的发生。
[Abstract]:Objective: to analyze retrospectively the clinical and imaging data of hepatic cystic hydatid cyst complicated with biliary fistula, and to explore the risk factors of hepatic cystic hydatid disease. Methods: from 2013 to 2016, 176 cases of hepatic cystic hydatid cyst complicated with biliary fistula were collected in our hospital. Ct examination was performed before operation. The patients were divided into two groups: 68 cases with biliary fistula group and 108 cases without biliary fistula group according to the results of operation. The imaging data of biliary fistula group were analyzed to provide imaging basis for preoperative diagnosis of biliary fistula. Results among 176 cases of biliary fistula, 68 cases were diagnosed by operation, and 16 cases were diagnosed by CT before operation. Direct communication between the bile duct and the lesion or dilatation of the distal bile duct were demonstrated in varying degrees. Among the 47 cases of biliary fistula which underwent MRI examination, 20 cases showed biliary fistula. MRI was performed in all 4 patients with biliary fistula without CT indication. No obvious intrahepatic bile duct dilatation was found on routine sequence. However, MRCP showed that the local wall of small bile duct around the lesion was not developed, whereas the imaging data of the patients with biliary fistula were not diagnosed before operation. It was found that the relevant characteristics of biliary fistula could not be found by conventional imaging examination. The ADC values of patients with biliary fistula and those without biliary fistula were 2.89 卤0.97) 脳 10 ~ (-3) mm ~ 2 / s and 3.11 卤0.83 脳 10 ~ (-3) mm ~ (2 / s), respectively. The difference was statistically significant. The variance analysis of the factors that may cause biliary fistula showed that there were three groups of data: hydatid disease history, cyst size, location, sex, age, hepatitis history. Classification is not a harmful factor in the occurrence of biliary fistula. Further analysis was made to determine the independent harmful factors associated with biliary fistula. The results showed that the total diameter of cysts was larger. Cyst located in the central segment of the liver is an independent and harmful factor that can easily lead to cystic hydatid fistula. For every 10 cm increase in the total diameter of hydatid cyst, the risk of biliary fistula increases by 6.395 times. The incidence of cysts in the central segment of the liver was 3.965 times higher than that in the peripheral segment. Conclusion: the preoperative diagnosis rate of biliary fistula is low. Conventional imaging combined with diffusion-weighted imaging is helpful to assist the diagnosis. MRCP can show clearly the fistula of hydatid cyst into the bile duct in multiple directions and angles. There are independent risk factors in the occurrence of biliary fistula. Understanding these risk factors is helpful to the decision of clinical treatment and reduces the complications of biliary fistula to a certain extent.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R532.32;R816.5;R445.2

【相似文献】