摘要目的 应用多排螺旋CT(MSCT)分析各种胆内瘘中的典型影像学特征,探讨其影像诊断价值.方法 回顾性分析2011年1月至2018年3月南京医科大学附属无锡第二医院收治的56例胆内瘘患者资料.所有患者均行MSCT平扫及增强检查,对各种胆内瘘影像学特征进行分析研究.结果 本组56例胆内瘘诊断总符合率85.7％(48/56),其中胆囊-十二指肠瘘,诊断敏感度87.2％(34/39).在胆囊与十二指肠、结肠及胃形成瘘道,21有例瘘道显示,11例表现的“狭颈征”.胆囊-胆管瘘、胆囊-肝瘘、胆总管-十二指肠瘘中共6例均显示瘘道.4例胆囊复杂瘘中3例清楚显示瘘口,其中2例共瘘口,呈“三叶草征”改变.56例胆内瘘的CT间接共同影像学特征:胆囊萎缩或显示不清;胆道系统结石嵌顿,胆囊或胆总管与空腔脏器成瘘中部分胆道系统积气等.结论 MSCT扫描不仅可以有效区分胆内瘘类型及瘘道结构,还可显示瘘道有无、形态以及胆囊萎缩、胆囊及胆管积气、结石及周围情况等,对手术方案制定有重要的指导意义.

abstractsObjective To analyze the typical imaging features of various internal biliary fistulas by multislice spiral CT (MSCT),and the diagnostic value.Methods the data of 56 cases of internal biliary fistula in Wuxi No.2 Affiliated Hospital of Nanjing Medical University from January 2011 to March 2018 were analyzed retrospectively.All cases were examined by MSCT plain scan and enhanced examination.The imaging features of various biliary fistula were analyzed and studied.Results Among 56 cases of biliary fistula,39 cases were gallbladder duodenum fistula,and the diagnostic sensitivity was 87.2％ (34/39).The total coincidence rate was 85.7％ (48/56).21 cases were fistula formation,and 11 cases of narrow neck syndrome.Gallbladder bile duct fistula,liver-gallbladder fistula,bile duct and duodenal fistula of 6 cases were showed.In 4 cases of complex gallbladder fistulas,3 cases showed fistula clearly including 2 cases of fistula and a "clover" sign.In the indirect CT signs of 56 cases of internal biliary fistula,the common imaging features:atrophy of gallbladder or incarceration,stone incarceration of biliary tract,gallbladder or choledochal duct and cavity viscera.Conclusion MSCT scan can not only distinguish the type of biliary fistula and the structure of fistula,but also display the fistula,shape,atrophy of gallbladder,gallbladder and bile duct gas,stone and surrounding conditions,which have important guiding significance for the formulation of the operation scheme.