【摘要】 目的探讨肝吸虫感染所致胆道梗阻的CT影像特点及误诊原因。方法收集5例CT误诊的肝吸虫团块所致胆道梗阻病例,2例经胆总管探查术证实,3例经逆行胰胆管造影+内镜下Oddis括约肌切开术证实。回顾性分析其CT征象和误诊原因。结果5例肝吸虫团块所致胆道梗阻术前CT全部误诊。分别误诊为胆总管结石1例,胆总管癌2例,壶腹癌1例,胰头癌1例。4例CT表现胆总管梗阻扩张伴有肝内胆管扩张迂曲,肝包膜下小胆管呈囊状或杵状扩张,胆囊扩大。1例CT表现仅有胆总管梗阻扩张,肝内胆管扩张不明显。结论在肝吸虫疫区,当CT影像表现为胆总管梗阻伴有肝包膜下小胆管呈囊状或杵状扩张时,需要考虑肝吸虫团块所致。更多还原

【Abstract】 Objective To explore the imaging features of CT and cause of misdiagnosis of common bile duct(CBD)obstruction due to clonorchiasis clumps. Methods The clinical data of 5 patients with CBD obstruction due to clonorchiasis clumps were analyzed retrospectively. Two cases were confirmed by CBD operation, and the other three were confirmed by endoscopic retrograde cholangiopancreatography(ERCP) + endoscopic sphincterectom(yEST). Results All five cases were misdiagnosed by CT before operation. One case was misdiagnosed to be choledocholith, two cholangiocacinoma, one carcinoma of Vater’s ampulla,one carcinoma of the head of pancreas. CT scanning showed intrahepatic bile duct diffuse dilatation with the end shaped like a bag in four cases, extrahepatic bile duct dilatation in five cases, and thicken walls of CBD or Vater’s ampulla in three cases. Conclusion In the epidemic area of clonorchiasis, the cause of CBD obstruction should be considered as clonorchiasis clumps, especially in those with specific dilated intrahepatic ducts.更多还原