CT胆道仿真内窥镜在胆总管下段阴性结石诊断中的应用  

Application value of CTVC in diagnosis of negative lower common bile duct stones

作　　者：李兴杰 桂普国 LI Xingjie;GUI Puguo(Department of Radiology,Ankang People’s Hospital,Ankang 725000,China)

机构地区：[1]安康市人民医院放射科,陕西安康725000 [2]杨凌示范区医院肝胆普外科,陕西杨凌712100

出　　处：《陕西医学杂志》2021年第5期559-562,567,共5页Shaanxi Medical Journal

基　　金：陕西省自然科学基础研究计划项目(2020JM-703)。

摘　　要：目的:探讨CT胆道仿真内窥镜(CTVC)在胆总管下段阴性结石诊断中的应用价值。方法:选取76例胆总管下段阴性结石患者作为研究对象,所有患者通过手术病理诊断为胆总管下段阴性结石,与术后结果对比观察螺旋CT薄层扫描、CTVC和内窥镜逆行胰胆管造影(ERCP)的诊断结果,分析CTVC在胆总管下段阴性结石中的诊断价值。结果:三种检测方法对左右肝管、肝总管、胆总管显示率对比均无统计学差异(均P>0.05),胆囊管和三、四级肝内胆管分支显示率对比均有统计学差异(均P<0.05),ERCP诊断显示率更高(P<0.05),但ERCP与CTVC对比无统计学差异(P>0.05);76例胆总管下段阴性结石患者,CTVC诊断的结石直径大小与术后手术确诊无明显差别,而且其诊断准确率均高于螺旋CT和ERCP(均P<0.05),三种检测方法对于胆管扩张检出数对比无统计学差异(P>0.05)。在阴性结石检出数上,CTVC的检出率最高(P<0.05),其中ERCP将6例患者误诊为气泡,2例患者诊断为正常,螺旋CT将23例患者诊断为炎性狭窄可能,有8例患者未诊断出确切异常。螺旋CT诊断不良反应发生率为1.32%,ERCP诊断不良反应发生率为15.18%,CTVC诊断不良反应发生率为3.95%,ERCP的诊断不良反应发生率明显高于其他两组(P<0.05);三种诊断方法的特异度、阴性预测值对比均无统计学差异(均P>0.05),CTVC检查的准确度、敏感度和阳性预测值明显高于ERCP和螺旋CT(均P<0.05)。结论:CTVC虽然诊断耗时多,需要静脉滴注胆影葡胺后再进行CT扫描,但是诊断无创伤,没有严重不良反应,对于胆总管下段阴性结石中的诊断与手术诊断病理结果相符,可以为患者提供更可靠的临床诊断依据。Objective:To compare the application of surgical pathological diagnosis and CT virtual endoscopy in the diagnosis of lower common bile duct stones.Methods:76 patients with negative lower common bile duct stones were selected as the research objects.All patients were diagnosed with negative lower common bile duct stones by surgical and pathological diagnosis.The diagnostic results of spiral CT thin-slice scan,CTVC and endoscopic retrograde cholangiopancreatography(ERCP)were compared with the postoperative results,and the diagnostic value of CTVC in negative lower common bile duct stones was analyzed.Results:The three detection methods showed no statistical difference in the display rate of left and right hepatic duct,common hepatic duct,and common bile duct(all P>0.05);there were statistical differences in the display rates of the cystic duct and the third and fourth grade intrahepatic bile duct branches(all P<0.05);the diagnosis rate of ERCP was higher(P<0.05),but there was no statistical difference between ERCP and CTVC(P>0.05).In 76 patients with negative lower common bile duct stones,the diameter of the stones diagnosed by CTVC was different from that of the postoperative diagnosis,and the diagnostic accuracy was higher than that of spiral CT and ERCP(all P<0.05).The three detection methods had no statistical difference in the number of bile duct dilatation detected(P>0.05).In terms of the number of negative stones detected,CTVC had the highest detection rate(P<0.05);ERCP misdiagnosed 6 patients as air bubbles,2 patients were diagnosed as normal,and spiral CT diagnosed 23 patients as possible inflammatory stenosis,and 8 patients were not diagnosed as abnormal.The incidence of adverse reactions in spiral CT,ERCP and CTVC was 1.32%,15.18%and 3.95%,respectively,and the incidence of adverse reactions in ERCP was significantly higher than that in other two groups(all P<0.05).The specificity and negative predictive value of the three diagnostic methods were not statistically different(all P>0.05),and the accuracy,se

关 键 词：胆总管下段阴性结石 诊断 CT胆道仿真内窥镜 螺旋CT 内窥镜逆行胰胆管造影 准确率 

分 类 号：R657.42[医药卫生—外科学]