以反复发作胆管炎为表现的肝内胆管囊腺瘤一例.doc

以反复发作胆管炎为表现的肝内胆管囊腺瘤一例 主堡壁堕型苤查!笙旦筮1—鲞身ChinJHepatobiliarySurg,August2007,Vo1.13,No.8 ofimagingfindings,Radiographics,2003,23:123—134. [jAkazawaS,OmagariK,AmenomoriM,eta1.Bronchobiliary fistulaassociatedwithintrahepaticbilomaaftertranscatheter arterialchemoembolizationforhepatocellularcarcinoma.f Hepato【,2004,40:1O45—1O66. [6]KhurooMs,Al—AshgarH,KhurooNs,eta1.Biliarydisease afterlivertransplantation:theexperienceoftheKingFaisal SpecialistHospitalandResearchCenter,Riyadh.JGastroen— terolHepatol,2005,20:217—228. [73KimsH,LimHK,ChoiD,eta1.Changesinbileductsafter radiofrequencyablationofhepatocellularcarcinoma:frequency andclinicalsignificance.AJR,2004,183:1611-1617. E83SafdarN,SaidA,LuceyMR,eta1.Infectedbilomasinliver transplantrecipients:clinicalfeatures,optimalmanagement, andriskfactorsformortality.ClinInfectDis,2004,39:517— 525. ?521? [93罗鹏飞,符力,陈晓明,等.肝癌介入治疗后胆?十瘤的形成与临 床意义.中华放射学杂志,2000,34:757—760. [1O3ChiuWC,WongYou,RodriguezA,etai.Uitrasonography forintervalassessmentinthenonoperativemanagementofhe— patictrauma.AmSurg,2005,71:841-846. [11jSakamotoI,1wanagaS,NagaokiK,eta1.Intrahepaticbiloma fDrmation(bileductnecrosis)aftretranscatheterarterialche～ moembolization.AJR,2003,181:79—87. [123SaidA,SafdarN,LuceyMR,eta1.Infectedbilomasinliver transplantrecipients,incidence,riskfactorsandimplications forprevention.AmJTransplant,2004,4:574-582. [13JTachopoulouOA,VogtDP,HendersonJM,eta1.Hepatic abscessafterlivertransp【antation:1990—2000.Transplanta— tion,2OO3,75:79—83. (收稿日期:200609—26) 以反复发作胆管炎为表现的肝内胆管囊腺瘤一例 李东方刘昌胜邢超 病人,女性,64岁,反复发作右上腹绞痛13年,加重3d 入院.病人于13年前无明显诱因出现右上腹痛伴恶心,呕 吐,并多次出现黄疸,发热,每年住院数次,皆诊断为胆管结 石伴胆管炎,予以抗生素,解痉,利胆治疗,3～5d后症状消 失.曾行CT检查提示左肝外叶胆管扩张.3d前又突发右 上腹绞痛伴黄疸,高热.入院查体:T39.7℃,巩膜黄染,右 上腹压痛并触及肿大的胆囊,CT示肝左叶萎缩,肝内外胆管 及胆囊明显扩张,胆总管下端变细.MRCP:胆总管下段结 石.保守治疗5d,症状完全消失.行ERCP检查:肝外胆 道,右肝管及其分支未见异常,左肝管内见充盈缺损且向肝 总管内突出,表面不规则,加压注入造影剂见充盈缺损充满 左肝管并可变形,未见远端扩张,胆囊显影,未见异常.用气 囊取出少许胶冻样物送病理,完成ERCP+气囊探查+ ENBD.诊断左肝管可变形充盈缺损,胆管黏液腺瘤,癌? 病理报告:胶冻样物为胆汁及黏液,无上皮成分.常规准备 后在气管插管全麻复合硬膜外麻醉下手术,探查左肝外叶明 显萎缩,纤维化,并呈囊性变,右肝,胆囊未见异常.切开胆 总管有