影像学检查对肝门胆管狭窄的临床诊断价值  

Clinical significance of imaging in the diagnosis of bile duct stenosis in hepatic portal

作　　者：倪克诚 季锡清[2] 

机构地区：[1]海军政立路干休所,上海200433 [2]北京军区总医院全军普通外科中心

出　　处：《海军医学杂志》2012年第3期172-174,共3页Journal of Navy Medicine

摘　　要：目的探讨分析肝门胆管狭窄常见病因并评价影像学检查对肝门胆管狭窄的诊断价值。方法回顾性分析1998—2007年北京军区总医院143例资料完整的肝门胆管狭窄患者病因及超声(US)、逆行胰胆管造影(ERCP)、经皮肝穿胆道造影(PTC)、磁共振胰胆管造影(MRCP)诊断结果,评价各影像检查对肝门胆管狭窄适应证及诊断价值。结果肝门胆管狭窄中恶性肿瘤占84.62%,良性病占15.38%。肝门胆管癌占72.73%,胆囊癌占6.98%,肝细胞癌并发门静脉癌栓2.80%,大肠癌肝门转移2.10%。良性狭窄以损伤性胆管、胆管囊肿、硬化性胆管炎、胆管结石及Mirizzi综合征多见。US、ERCP、PTC及MRI+MRCP诊断肝门胆管狭窄的准确率分别为84.62%、92.71%、100.00%、100.00%。结论现代影像学检查在鉴别肝门胆管狭窄良恶性病变方面具有重要的诊断价值,对其良恶性病灶可切除性进行准确的术前判断。Objective To investigate and analyze etiology of bile duct stenosis in hepatic portal and to evaluate the value of imaging in the diagnosis of bile duet stenosis in hepatic portal. Methods A retrospective study was made on the data of 143 cases with bile duct stenosis in hepatic portal hospitalized in the General Hospital of Beijing Military District from 1998 to 2007, and also on the diagnostic results of ultrasonography （ US ） , endoscopic retrograde cholangiopancreatography （ ERCP ）, percutaneous transhepatic cholangiography （PTC） and magnetic resonance cholangiopancreatography （MRCP）. Assessment was also made on the indication and value of various imaging techniques for the diagnosis of bile duct stenosis in hepatic portal. Results In the cases of bile duct stenosis in hepatic portal, malignant and benign tumors accounted for 84.62% and 15.38% respectively. Also in the cases of bile duct stenosis, carcinoma of bile duct in hepatic portal accounted for 72.73% , carcinoma of gallbladder accounted for 6.98% , hepatocellular carcino- ma complicated with portal vein tumor embolism accounted for 2.80% and hepatic portal metastasis of large intestine carcinoma accoun- ted for 2.10%. Benign stenosis was chiefly due to injured bile duct, bile duct cyst, sclerotic eholangitis, bile duct calculi and the Mi- rizzi syndrome. The diagnostic accuracy of US, ERCP, PTC, and MRCP in the diagnosis of bile duct stenosis in hepatic portal was 84. 62% , 92.71% , 100% , and 100% respectively. Conclusion Modern imaging techniques were of great diagnostic value in the dif- ferentiation of malignant or benign pathologic changes of bile duct stcnosis in hepatic portal, and could help medical people to make more accurate pre-surgery decisions on the operability of malignant or benign foci.

关 键 词：肝门胆管狭窄 超声 磁共振胰胆管造影 逆行胰胆管造影 经皮肝穿刺胆道造影 鉴别诊断 

分 类 号：R445[医药卫生—影像医学与核医学]