背景:胆道扩张是一种罕见的疾病,涉及肝内和肝外胆道异常。随着成像技术的发展,越来越多的特殊病例被诊断出来,这对传统的分类方法提出了挑战。
方法:一名50岁女性因右上腹疼痛10天以上入院。患者以前有过类似症状的发作,在当地社区医院对症治疗后缓解。症状出现后,她在当地医院做了计算机断层扫描,显示胆道扩张;因此,她被转介到我们医院接受进一步治疗。入院后,她的磁共振成像检查也提示胆道扩张,但在她的十二指肠发现了异常信号.首先,考虑十二指肠憩室。稍后,进行了内窥镜超声检查,结果提示扩张的胆道已突出到十二指肠。这种类型的病变最接近地分类为TodaniIII型病变。患者最终接受了胆总管切除术和Roux‑en‑Y肝空肠吻合术,术后病理与我们的术前诊断一致。患者随访约2年,术后无明显并发症。
结论:这种情况的表现相对罕见,涉及托达尼分类系统中未讨论的类别之一;因此,该病例具有一定的临床应用价值。此外,在以前的文献中没有类似这种经验的报道。
BACKGROUND: Biliary dilatation is a rare disease involving intrahepatic and extrahepatic biliary tract abnormalities. With the development of imaging technology, an increasing number of special cases have been diagnosed, which poses a challenge to the traditional classification method.
METHODS: A 50-year-old woman was admitted to the hospital due to right upper quadrant pain for more than 10 days. The patient had previous episodes of similar symptoms, which were relieved after symptomatic treatment at a local community hospital. After the symptoms developed, she underwent a computed tomography scan at the local hospital, which showed biliary dilatation; thus, she was referred to our hospital for further treatment. After admission, her magnetic resonance imaging examination also suggested biliary dilatation, but abnormal signals were found in her duodenum. First, a duodenal diverticulum was considered. Later, endoscopic ultrasonography was conducted, and the results suggested that the dilated biliary tract had herniated into the duodenum. This type of lesion is most closely classified as a Todani type III lesion. The patient finally underwent choledochectomy and Roux‑en‑Y hepaticojejunostomy, and the postoperative pathology was consistent with our preoperative diagnosis. The patient was followed up for approximately 2 years, and no obvious postoperative complications were found.
CONCLUSIONS: The manifestations of this
case are relatively rare and involve one of the undiscussed categories of the Todani classification system; therefore, this
case has certain clinical value. Moreover, there is no report similar to this experience in the previous literature.