MRCP对ERCP胆管插管难度预测的价值  

Role of MRCP in predicting difficulty of bile duct intubation during ERCP

作　　者：朱恒[1] 赵清喜[1] 孙学国[1] 王小玮[1] 鞠辉[1] 毛涛[1] 田字彬[1] 

机构地区：[1]青岛大学医学院附属医院消化科,山东省青岛市266003

出　　处：《世界华人消化杂志》2013年第4期357-361,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)对内镜下逆行胆胰管造影术(endoscopic retrograde cholangiopancreatography,ERCP)胆管插管难度预测的价值.方法:采用回顾性分析方法,收集93例术前行MRCP检查的ERCP患者,根据ERCP胆管插管难易程度将患者分为ERCP胆管插管困难组(A组,30例)和非困难组(B组,63例).对两组患者MRCP图像上相关解剖学指标(包括胆总管直径、胰管直径、胆胰管汇合角度、胆胰管汇合点与十二指肠内壁间距、胆胰管末端间距)进行观察和测量,比较分析两组患者MRCP图像上述解剖指标数据的差别,探讨其对ERCP胆管插管难度预测的价值.结果:ERCP胆管插管成功率为98.92%.两组患者MRCP上胆总管直径、胆胰管汇合角度存在差异(4.48±1.27 vs 6.73±2.32;25.89±14.40 vs 43.37±24.88,P<0.05),而两组患者性别、年龄、胰管直径、胆胰管汇合点与十二指肠内壁间距、胆胰管末端间距的差异无统计学意义.ERCP胆管插管难度与MRCP图像上胆总管直径、胆胰管汇合角度有相关性(P<0.05),而与胰管直径、胆胰管汇合点与十二指肠内壁间距、胆胰管末端间距无相关性.结论:ERCP术前常规行MRCP检查对判定ERCP胆管插管难易程度有一定指导意义.AIM：To evaluate the value of some anatomical indexes on MRCP images in the prediction of difficulty of bile duct intubation during ERCP.METHODS：Clinical data for 93 patients who had undergone MRCP before ERCP treatment from November 2011 to June 2012 at the Affiliated Hospital of Qingdao University Medical College were retrospectively analyzed.The patients were classified into two groups,group A（n=30）,in which bile duct intubation during ERCP was difficult,and group B（n=60）,in which bile duct intubation was easy.Five main indexes,including common bile duct diameter,pancreatic duct diameter,separation angle between the common bile duct and the pancreatic duct,the distance between the duodenal wall and the con？ uence of the common bile duct and the pancreatic duct,and the distance between the openings of the common bile duct and the pancreatic duct in the duodenum,were measured on MRCP images and compared between the two groups to find indexes which can forecast difficulty of bile duct intubation during ERCP.RESULTS：The success rate of ERCP was 98.92%.There were significant differences between the two groups in the common bile duct diameter and separation angle between the common bile duct and the pancreatic duct（4.48 ±1.27 vs 6.73±2.32;25.89±14.40 vs 43.37±24.88,both P0.05）.CONCLUSION：MRCP may be helpful to predict difficulty of bile duct intubation during ERCP and to choose the best treatment for patients with biliary tract disease.

关 键 词：内镜下逆行胆胰管造影术 磁共振胰胆管成像 胆胰疾病 胆胰管解剖 困难插管 

分 类 号：R575.7[医药卫生—消化系统]