常用影像学方法对于急诊胆道梗阻患者的诊断价值  

Diagnostic value of common iconography methods for patients with obstruction of biliary tract in emergency treatment

作　　者：魏红涛[1] 张天鹏[1] 刘冰[1] 王振洲[1] 章建东[1] 王国兴[1] WEI Hong-tao;ZHANG Tian-peng;LIU Bing(Department of Emergency,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China.)

机构地区：[1]首都医科大学附属北京友谊医院急诊科,北京100050

出　　处：《中国医学装备》2018年第8期63-66,共4页China Medical Equipment

基　　金：北京市医院管理局临床医学发展专项"扬帆"计划(ZYLX201802)"急性重症感染分层诊疗"

摘　　要：目的:探讨腹部超声(AUS)、电子计算机断层扫描(CT)、磁共振胰胆管造影(MRCP)和经内镜逆行性胰胆管造影术(ERCP)4种影像学方法对于急诊胆道梗阻患者的诊断价值。方法:回顾性分析46例胆道梗阻患者的病因诊断及影像学资料,按照胆道梗阻原因将患者分为胆总管结石亚组(27例)和非结石亚组(19例),其中包括已排除胆总管结石但最终未明确诊断的9例患者,比较分析所有患者4种检查方法的检出率,以及AUS检查未能确诊患者的CT、MRI和ERCP检出率。结果:对于所有患者及胆总管结石亚组患者,CT、MRCP和ERCP的诊断价值均高于AUS的诊断价值,CT、MRCP和ERCP与AUS的诊断检出率比较,其差异均有统计学意义(x^2=10.343,x^2=5.124,x^2=8.521;P<0.05);在非结石亚组患者中,CT、MRCP及ERCP的诊断价值要高于AUS,但差异无统计学意义;对于胆道梗阻患者,CT、MRCP和ERCP间诊断价值均无统计学差异。结论:CT、MRCP及ERCP对急诊胆道梗阻患者的诊断价值相似,均优于AUS诊断。Objective： To explore the diagnostic values of 4 iconography methods that included abdominal ultrasonography（AUS）, computed tomography（CT）, magnetic resonance cholangiopancreatography（MRCP） and endoscopic retrograde cholangiopancreatography（ERCP） for patients with obstruction of biliary tract in emergency treatment. Methods： Data of etiology diagnosis and iconography of 46 patients with obstruction of biliary tract were retrospectively analyzed. All of patients were divided into choledocholithiasis subgroup（n=27） and noncholedocholithiasis subgroup（n=19） according to the cause of the obstruction of biliary tract. And those patients of non-choledocholithiasis subgroup included 9 patients who didn＇t got clear diagnosis but choledocholithiasis had been eliminated. Relevance rate of the four examination methods were compared and analyzed for all of these patients. And the relevance rate of CT, MRCP and ERCP of patients without confirmed diagnosis by using AUS were also compared. Results： The diagnostic values of CT, MRCP and ERCP were significantly higher than that of AUS in all of patients and patients of choledocholithiasis subgroup, and the differences of relevance rates between anyone of them and AUS were significant（x2=10.343, x2=5.124, x2=8.521, P〈0.05）, respectively. In non-choledocholithiasis subgroup, the diagnostic values of CT, MRCP and ERCP were higher than that of AUS, but the differences between anyone of them and AUS respectively were not significant. For patients with obstruction of biliary tract, the differences of diagnostic values among CT, MRCP and ERCP were not statistically significant. Conclusion： Using CT, MRCP, and ERCP have the similar diagnostic value for patients with obstruction of biliary tract, and their diagnoses are better than that of using AUS.

关 键 词：胆道梗阻 胆总管结石 超声检查 电子计算机断层扫描 磁共振胰胆管造影 

分 类 号：R445[医药卫生—影像医学与核医学]