PTC对胰胆管合流异常的鉴别诊断  

The clinical value of PTC findings in the differentiation of pancreaticobiliary maljunctions

作　　者：赵明[1] 李臻[2] 韩新巍[2] 张川[1] 张蓓[1] 

机构地区：[1]上海市瑞金医院集团闵行中心医院放射科,201100 [2]郑州大学第一附属医院放射科

出　　处：《介入放射学杂志》2009年第7期543-546,共4页Journal of Interventional Radiology

摘　　要：目的探讨经皮肝穿刺胆道造影(PTC)诊断胰胆管合流异常(PBM)的可行性、影像学表现及其与Oddi括约肌功能异常(SOD)的影像学鉴别诊断。方法回顾性分析363例阻塞性黄疸患者行PTCD治疗的临床及影像学资料,确立病例入选标准、PBM诊断参考标准。由2名高年资医师阅片,分析临床资料完整的胰管显影病例,影像学测量其胆胰共同管长度,并经校正得到实际数值,与正常值进行统计学比较。对非PBM型胰管显影者分析,结合临床及现行的SOD临床诊断标准,作出初步诊断。结果42例胰管显影的病例中,临床初诊PBM38例,SOD4例。PTC显示38例PBM患者胆总管、胰管在十二指肠壁外高位汇合,共同管较长,为(12.6±7.9)mm,明显高于正常长度标准6mm(t=5.15,P<0.05);且十二指肠乳头开口越远,共同管越长。4例SOD中,1例为胆囊切除术后综合征,3例考虑为胰胆管间纵行括约肌缺如。结论PTC是诊断PBM的可行方法之一,结合临床可初步与SOD影像诊断相鉴别。但诊断PBM首选无创性诊查方法。Objective To investigate the feasibility of diagnosing pancreaticobiliary maljunction （PBM）by means of percutaneous transhepatic cholangiopancreatography （PTC） and to discuss the imaging characteristics of PBM as well as the differentiation with Oddi＇s sphincter dysfunction. Methods The clinical data and imaging findings of consecutive 363 patients, who underwent PTCD therapy due to obstructive jaundice and were encountered in our hospital from Jan. 1999 to Mar, 2008, were retrospectively analyzed. The selective criteria and the reference diagnostic standards were established. The images were reviewed by two experienced radiologists. For patients with intact clinical data and visualization of pancreatic duct, the length of pancreaticobiliary common duct was measured, adjusted and statistically compared with normal value. For patients with visualization of pancreatic duct of non-PBM, the initial diagnosis＇ was made based on the combined evidence of clinical findings with current clinical diagnostic criteria. Results Of 42 patients with visualization of pancreatic duct, diagnosis of PBM was initially made in 38 and diagnosis of Oddi＇s sphincter dysfunction was made in 4. In 38 cases of PBM, the pancreatic duct and common biliary duct joined together at high position of the duodenum with a longer common duct of （12.6±7.9） mm, which was significantly longer than the regular length of 6 mm （t = 5.15, P 〈 0.05）. Moreover, the more distant the location of duodenal papilla orifice was, the longer the common duct would be. Of 4 cases with Oddi＇s sphincter dysfunction, postoperative syndrome of gallbladder was seen in one and longitudinal sphincter deficiency between pancreatic duct and biliary duct＇was suggested in 3. Conclusion PTC is a safe and practicable imaging method to diagnose PBM. Based on PTC findings and clinical manifestations, differentiation of PBM with Oddi＇s sphincter dysfunction can be made. However, in the diagnosis of PBM non-invasive technique should be the exam of first

关 键 词：胰胆管合流异常 影像诊断 经皮肝穿刺胆管造影术 ODDI括约肌功能异常 

分 类 号：R816.5[医药卫生—放射医学]