本文關(guān)鍵詞：肝囊型包蟲合并膽瘺的臨床及影像資料分析　出處：《青海大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的:回顧性分析肝囊型包蟲合并膽瘺的臨床及影像學(xué)資料,探討肝囊型包蟲病發(fā)生膽瘺的危險因素,并為肝囊型包蟲合并膽瘺提供一定的影像學(xué)依據(jù)。方法:收集2013年-2016年在我院行肝囊型包蟲手術(shù)治療的病例,共176例,術(shù)前均行CT檢查,部分行MRI檢查,了解患者臨床表現(xiàn)及相關(guān)實(shí)驗(yàn)室檢查,根據(jù)手術(shù)結(jié)果有無合并膽瘺將病例分為有膽瘺組68例和無膽瘺組108例,分析膽瘺組的影像學(xué)資料,為膽瘺的術(shù)前診斷提供影像學(xué)依據(jù)。統(tǒng)計可能導(dǎo)致膽瘺的7個危險因素,用單因素和多因素方差分析確定膽瘺發(fā)生的獨(dú)立危險因素。結(jié)果:176例病例中,共68例經(jīng)手術(shù)確診合并膽瘺,其中術(shù)前CT提示膽瘺16例,不同程度顯示膽管與病灶之間直接交通或病灶遠(yuǎn)端膽管擴(kuò)張、走行迂曲。47例行MRI檢查的膽瘺病例中,提示膽瘺20例,CT未提示膽瘺的4例患者均行MRI,于常規(guī)序列未發(fā)現(xiàn)明顯的肝內(nèi)膽管擴(kuò)張,而MRCP均顯示病灶周邊細(xì)小膽管局部管壁未顯影。反觀術(shù)前未診斷出膽瘺的病例影像資料,發(fā)現(xiàn)常規(guī)影像學(xué)檢查尚不能找到支持膽瘺的相關(guān)特征。對病灶囊液進(jìn)行彌散定量測定;有膽瘺組及無膽瘺組ADC值分別為(2.89士0.97)×10-3mm2/s、(3.11士0.83)×10-3mm2/s,差異有統(tǒng)計學(xué)意義。對可能導(dǎo)致膽瘺的因素進(jìn)行方差分析得出::有包蟲病手術(shù)史、囊腫大小、位置3組數(shù)據(jù)有統(tǒng)計學(xué)差別,性別、年齡、肝炎病史、分型不是膽瘺發(fā)生的有害要素。進(jìn)一步分析確定并發(fā)膽瘺的獨(dú)立有害要素。結(jié)果顯示囊腫總徑線越大、囊腫位于肝臟中央段是容易導(dǎo)致肝囊型包蟲膽瘺的發(fā)生的獨(dú)立有害要素。包蟲囊腫總徑線每增加10厘米,膽瘺的可能增進(jìn)6.395倍,囊腫位于肝內(nèi)中央段比位于外周段合并膽瘺的機(jī)率增進(jìn)3.965倍。結(jié)論:膽瘺術(shù)前診斷率低,常規(guī)影像學(xué)檢查結(jié)合擴(kuò)散加權(quán)成像有利于輔助診斷。MRCP能多方位、多角度、清楚的顯示包蟲囊腫瘺入膽道的情況,觀察受累膽道管腔的程度和范圍。膽瘺的發(fā)生有其獨(dú)立的危險因素,了解這些危險因素有助于臨床治療的決策,一定程度上減少了膽瘺并發(fā)癥的發(fā)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 鹵0.97) 脳 10 ~ (-3) mm ~ 2 / s and 3.11 鹵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.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R532.32;R816.5;R445.2

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