胆石症患者腹部增强CT扫描表现特征及其临床决策与转归分析*

doi:10.3969/j.issn.1672-5069.2025.05.035

摘要/Abstract

摘要： 目的分析总结胆石症患者增强CT检查表现特征及其对临床决策的指导作用。方法 2022年5月～2024年4月我院诊治的160例胆石症患者,均接受增强CT检查,分析总结胆石症的影像学表现特征,常规给予个体化的手术和内科治疗,观察转归情况。结果在160例胆石症患者中,发现胆囊结石46例,胆管结石54例和胆囊合并胆管结石60例;本组肝内胆管扩张发生率为60.0%,肝实质密度改变为30.0%和胆管壁增厚为32.5%;胆管结石和胆囊合并胆管结石患者肝内胆管扩张发生率分别为77.8%和80.0%,均显著高于胆囊结石患者的21.7%(P＜0.05),胆管壁增厚发生率分别为51.9%和60.0%,均显著高于胆囊结石患者的17.4%,差异均具有统计学意义(P＜0.05);胆管结石和胆囊合并胆管结石患者并发胆管炎发生率分别为44.4%和46.7%,均显著高于胆囊结石患者的8.7%(P＜0.05),肝脓肿发生率分别为11.1%和13.3%,均显著高于胆囊结石患者的0.0%,差异均具有统计学意义(P＜0.05);经腹腔镜胆囊切除术(LC)、经内镜逆行胰胆管造影(ERCP)胆管取石术和抗感染治疗,本组患者恢复良好。结论增强CT检查能够清晰地显示胆石症患者肝胆影像学表现,为疾病分型诊断和并发症评估提供了可靠的依据,对个体化治疗决策起到重要的指导作用。

关键词: 胆石症, 增强CT检查, 影像学特征, 临床决策, 个体化治疗

Abstract: Objective The aim of this study was to summarize enhanced CT scan features of patients with cholelithiasis and their guidance on clinical decision-making. Methods 160 patients with cholelithiasis were encountered in our hospital between May 2022 and April 2024, and all of them underwent enhanced CT scan. Clinical management included laparoscopic cholecystectomy (LC), endoscopic retrograde cholangiopancreatography (ERCP) and antibiotics. Results Of the 160 patients with cholelithiasis, cholecystolithiasis was found in 46 cases, cholangiolithiasis in 54 cases and cholecystolithiasis/cholangiolithiasis in 60 cases; in our series, incidence of bile duct dilatation was 60.0%, intrahepatic density changes was 30.0% and bile duct wall thickening was 32.5%; incidences of intrahepatic bile duct dilatation in patients with cholangiolithiasis and cholecystolithiasis/cholangiolithiasis were 77.8% and 80.0%, both much higher than 21.7%(P＜0.05)in patients with cholecystolithiasis, incidences of bile duct wall thickening were 51.9% and 60.0%, both much higher than 17.4% (P＜0.05)in patients with cholecystolithiasis; incidences of complicated cholangitis in patients with cholangiolithiasis and cholecystolithiasis/cholangiolithiasis were 44.4% and 46.7%, both much higher than 8.7%(P＜0.05) in patients with cholecystolithiasis, incidences of liver abscess were 11.1% and 13.3%, both much higher than 0.0%(P＜0.05)in patients with cholecystolithiasis; all patients in our series recovered after personalized LC, ERCP and/or supporting therapy. Conclusion Enhanced CT scan could clearly display imaging features of patients with cholelithiasis, which might provide a reliable basis for disease classification, complications assessment and individualized treatment decision-making.

Key words: Cholelithiasis, Enhanced CT scan, Imaging feature, Clinical decision-making, Individualized treatment

高峻坤, 卞鹏宇, 汤玉香. 胆石症患者腹部增强CT扫描表现特征及其临床决策与转归分析^*[J]. 实用肝脏病杂志, 2025, 28(5): 780-783.

Gao Junkun, Bian Pengyu, Tang Yuxiang. Enhanced CT scan features of patients with cholelithiasis and guidance on clinical decision-making: Analysis of 160 caces[J]. Journal of Practical Hepatology, 2025, 28(5): 780-783.

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胆石症患者腹部增强CT扫描表现特征及其临床决策与转归分析^*

Enhanced CT scan features of patients with cholelithiasis and guidance on clinical decision-making: Analysis of 160 caces

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