论著-头颈部
胆总管结石应用 CT、MRCP和超声内 镜诊断的临床价值 对比研究
作者:张 伟 刘 莉 田 英
所属单位:湖北省襄阳市中心医院(湖北文理 学院附属医院)超声科 (湖北 襄阳 441021)
PDF摘要
目的 探讨体层摄影(CT)、 磁共振胰胆管成像(MRCP)与超声内镜 (EUS)应用于胆总管结石的诊断效果。 方法 回顾性分析114例B超疑似胆总管 结石患者临床资料,根据后续检查方法 选择分为CT组(n=37)、MRCP组(n=45)与 EUS组(n=32)。以内镜逆行胰胆管造影 (ERCP)为“金标准”,分析三组检查方 法与ERCP的一致性及诊断符合率差异。 结果 三组经ERCP确诊胆总管结石比率分 别为54.05%(20/37)、57.78%(26/45)、 65.62%(21/32),组间比较差异无统计 学意义(P>0.05)。三组诊断胆总管 结石符合率分别为85.00%(32/37)、 88.46%(41/45)、93.75%(30/32),组间 比较无统计学意义(P>0.05),且在诊断 胆总管结石方面与ERCP一致性均属良好 (Kappa>0.70)。结论 CT、MRCP及EUS诊 断胆总管结石效能均较高,临床可根据实 际情况进行灵活选择。
Objective To explore the diagnostic effects of computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) in the diagnosis of choledocholithiasis. Methods The clinical data of 114 patients which suspected as choledocholithiasis by ultrasound were analyzed retrospectively. The patients were divided into CT group (n=37), MRCP group (n=45) and EUS group (n=32) according to the follow-up examination methods. Endoscopic retrograde cholangiopancreatography (ERCP) was used as the gold standard to analyze the consistency and diagnostic coincidence rate of the three groups. Results The choledocholithiasis ratios diagnosed by ERCP in the three groups were 54.05% (20/37), 57.78% (26/45) and 65.62% (21/32) respectively (P>0.05). The coincidence rates of the three groups in the diagnosis of choledocholithiasis were 85.00% (32/37), 88.46% (41/45) and 93.75% (30/32) respectively (P>0.05), and they were well consistent with ERCP in the diagnosis of choledocholithiasis (Kappa>0.70). Conclusion CT, MRCP and EUS have ideal efficacy in the diagnosis of choledocholithiasis, and the method can be flexibly selected for patients in clinical practice.
【关键词】胆总管结石;体层摄影;磁共 振胰胆管成像;超声内镜
【中图分类号】R575.7
【文献标识码】A
【DOI】 10.3969/j.issn.1672- 5131.2019.06.027
前言
胆总管结石作为典型的胆道系统疾病,占胆石症患者总数 10%~15%[1],多表现为发热、右上腹疼痛及黄疸等症状,可继发急性胆 管炎、急性胆源性胰腺炎等危急重症。目前临床仍以内镜逆行胰胆管 造影(ERCP)为公认确切的诊断措施与取石途径,但由于涉及内镜下括 约肌切开与乳头球囊扩张等侵入性操作,有可能引起胆道感染、胆管 炎或复发性胆总管结石等多种并发症[2]。体层摄影(CT)、磁共振胰胆管 成像(MRCP)及超声内镜(EUS)均是当代肝胆外科最常用的影像学手段, 三者在胆总管结石诊断学中均占据重要地位[3]。对此,本研究旨在对 CT、MRCP、EUS诊断胆总管结石的效能进行对比,现将结果汇报如下。
中国CT和MRI杂志
第17卷, 第 6 期
2019年06月
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