上消化道钡餐中肝胆系显影８例Ｘ线分析
［摘要］ 目的：旨在提高对十二指肠胆囊或胆总管瘘及奥狄氏括约肌闭锁不全的认识。方法：对8例上消化道钡餐检查中肝胆系显影的原因及X线表现进行总结分析，其中7例经手术病理证实。结果：8例中十二指肠胆囊瘘2例、十二指肠胆总管瘘4例，６例中十二指肠溃疡4例，化脓性胆囊炎1例，肿瘤浸润1例；另2例奥狄氏括约肌闭锁不全，其中1例为胃底贲门癌伴胃周及腹膜后淋巴结转移浸润所致，1例原因不明。钡餐X线检查可显示钡剂逆流入胆总管及肝内胆管，6例可显示瘘管，2例钡剂通过失效的奥狄氏括约肌口流入总胆管。结论：胃及十二指肠和肝胆道因炎症、溃疡、肿瘤浸润等均可造成十二指肠胆囊或胆总管瘘及奥狄氏括约肌闭锁不全，钡餐X线检查可明确诊断。
Xray Analysis of Display of the Bilillary System in Upper Alimentary Tract Barium Meal Exzaminations in 8 Cases。
Abstract:Objective To improve the knowledge of cholecystoduodenal fistula,choledochoduodenal fistula and Oddi‘s sphincter insufficiency.Methods 7 of 8 cases were confirmed surgically and pathologically.The causes and Xray manifestations of display of the bilillarysystem in upper alimentary tract barium meal exzaminations were analysed.Results 2 cases of Cholecystoduodenal fistula and 4 cases of choledochoduodenal fistula were caused by duodenal ulcers,purulent cholecystitis and tumor infiltration in 4,1,1 respectively.1 case of Oddi‘s sphincter insufficiency caused by lymphoid node metastases and infiltration in peristomach and retroperitonium,and the cause was unknown in the other one From the fistulas and relaxed Oddi‘s sphincter bariumcontrast medium refluxed into choledochus，cholecyst and intrahepatic duct could be discovered,and fistulas displayed in 6 cases in Xray barium meal exzaminations.Conclussion Gastroduodenal ulcer,the bilillary system inflammation and tumormetastases and infiltration can result in cholecystoduodenal fistula,choledochoduodenal fistula and Oddi‘s sphincter insufficiency,which can display in Xray barium meal exzaminations.
Key words：Bilillary system fistula；Oddi‘s sphincter insufficiency；Xray barium meal exzamination。
十二指肠胆囊或胆总管瘘及奥狄氏括约肌闭锁不全较少见［１～5］，偶然在上消化道钡餐检查中发现肝胆系显影而作出诊断。肝胆道与胃和十二指肠在解剖部位上紧密相邻，当二者因某种疾病致瘘管形成或从失效的奥狄氏括约肌口流入总胆管，使肝胆系显影。现就我院在上消化道钡餐检查中发现的8例(其中经手术病理证实7例)总结如下。
1 材料与方法。
本组8例，男5例，女3例，年龄38岁~71岁，平均年龄52岁。临床主要表现为上腹部不适数月或数年不等。行常规上消化道钡餐检查及点片。8例中7例经手术及病理证实，其中十二指肠胆囊瘘2例,十二指肠胆总管瘘4例,6例中十二指肠溃疡4例，化脓性胆囊炎1例，胃癌浸润1例；另2例奥狄氏括约肌闭锁不全，其中1例为胃底贲门癌伴胃周及腹膜后淋巴结转移浸润所致，1例原因不明。
2 结果。
2.1 X线表现 行上消化道钡餐检查胃炎4例，胃底、贲门癌、胃窦部癌各1例，十二指肠球部溃疡3例，球后部溃疡1例。检查过程中见钡剂于十二指肠部后壁向上异常分流至胆囊2例，经十二指肠球部及降段上段内后壁异常分流至总胆管4例，经十二指肠降段内侧缘十二指肠乳头流人总胆管2例，随即总胆管或胆囊以及左、右肝管可见显影，似肝胆系造影所见(见图１～图３)。8例中总胆管扩张2例，左、右肝管扩张3例，胆囊结石1例，胆管结石2例，总胆管及左、右肝管“软腾”扩张2例。
2.2 手术病理 十二指肠球部溃疡致十二指肠胆囊瘘1例，十二指肠总胆管瘘3例，化脓性胆囊炎致胆囊十二指肠瘘1例，上消化道肿瘤并周围器官广泛浸润致十二指肠总胆管瘘1例，奥狄氏括约肌闭锁不全1例。术中发现胆囊结石1例，总胆管结石1例，慢性胆囊炎2例。