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Results All cases could display an enhanced mass as local filling defect at the site of the duodenal Vater′s ampulla during arterial and portal phase scanning, the tumors ranged in size from 1 cm to 5 cm with mean of 2.3 cm, all were accompanied with dilated intrahepatic and common bile duct, enlarged gallbladder and dilated pancreatic duct, except one case which had marked atrophy of the pancreatic body and tail.
结果螺旋CT动脉和门脉期增强扫描，15例均清晰显示十二指肠乳头部局限性强化的充盈缺损块影，肿瘤瘤径为1～5 cm，平均2.3 cm。所有病例均可见肝内胆管扩张、胆囊增大、胆总管扩张和胰腺管的扩张，仅有1例伴胰体尾部的明显萎缩。
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There were portal collateral vessels around the main portal vein in 8 patients and among them, there was 1 patient with the varix of gallbladder wall, 2 with gastroepiploic varix, 1 with varix on the bile duct wall, 1 with open of the retroperitoneal-paravertebral vein and the splenorenal vein, and 1 with open of the retroperitoneal-paravertebral vein.
结果 在门脉闭塞后，引起相应血管的纡曲扩张及侧支血管的形成，其中有门脉周围形成门－门侧支循环，胆囊壁静脉的曲张，胃网膜静脉的增粗纡曲，胆管壁静脉的纡曲扩张，腹膜后椎体旁侧支血管的开放，脾－肾静脉短路的开放，胃底食管静脉的曲张。
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Portal braches of 4-5 orders were found in all 19 cases of Child Grade I, with esophageal varices and paragastric varices and no fistula of hepatic artety-portal vein or portal vein embolus; Portal braches of 3-4 orders were displayed in all 16 cases of Child Grade II, besides esophageal varices and paragastric varices, cirsomphalos, retroperitoneal varices, paraesophageal varices, dilated azygos vein were also noted, some patients had fistula and portal vein embolus; in Child Grade III, portal branches of 3~4 orders were displayed with more collateral circulations, dilated left renal vein and paragallbladder varices were appeared, with fistula and portal vein embolus or not.
Child I级19例，肝内门静脉显影4~5级，侧枝循环以食管及胃周静脉曲张为主，没有肝动脉－门静脉瘘或门静脉血栓形成；Child Ⅱ级16例，肝内门静脉显影3~4级，侧枝循环除食管及胃周静脉外，脐周静脉、腹膜后静脉、食管周围静脉、奇静脉也有所开放，部分有肝动脉－门静脉瘘或门静脉血栓形成；Child Ⅲ级6例，肝内门静脉显影3~4级，侧枝循环开放较Ⅱ级增多，可出现左肾静脉扩张或胆囊周围静脉曲张，伴或不伴有肝动脉－门静脉瘘或门静脉血栓形成。16排螺旋CT门静脉造影对上述病例分级为一级17例，二级18例，三级6例，与Child分级结果高度相关。
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Objective To explore clinic application of endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for the treatment of the cholecystic stone combined bile duct disease.
目的 探讨逆行胰胆管造影术联合腹腔镜胆囊切除术对胆囊结石伴胆管病变治疗的临床应用方法 27例胆囊结石伴胆道病变患者，先用ERCP、乳头切开术取石；或ERCP和鼻胆管引流及柱状气囊扩张术治疗，术后3～11天，患者无发热、腹痛，血淀粉酶正常，再按常规四孔法施行LC。
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Conventional CT showed 44 cases of edematous type, dynamic contrast enhanced CT found 28 cases had different degree of necrosis of the pancreatic tissue, 6 cases were found to have focal hemorrhage, peripancreatic fluid accumulation were found in 32 cases, pseudocyst were found in 3 cases, abscess in 2 cases.
常规平扫显示胰腺水肿44例，动态增强扫描显示28例出现不同程度的胰腺组织坏死，6例检出局灶性出血；胰周液体聚集32例；假性囊肿3例，脓肿2例；伴胆石症15例，胆囊肿大或胆囊壁增厚22例；胆急管扩张12例，胰管扩张5例；胸腔积液11例。
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choledocholithiasis：胆总管结石
胆总管结石(choledocholithiasis)多位于胆总管的中下段,但随着结石增多、增大和胆总管扩张、结石堆积或上下移动,常累及肝总管. 据其来源,将在胆总管内生成的结石和肝内胆管内生成后下降至胆总管的结石,称为原发性胆总管结石;在胆囊内生成后排至胆总管的结石,