ERCP结合憩室造影对乳头旁憩室综合征的诊断价值  

Lemmel's Syndrome: Role of ERCP Combined with Diverticulography Compared with Conventional ERCP

作　　者：杨小庆[1] 龚永驰[1] 李国强[2] 杨爱玲[3] 邵华[4] 储成凤[1] 刘顺英[4] 张有珍[4] 

机构地区：[1]东南大学附属中大医院放射科,江苏南京210009 [2]东南大学附属中大医院普外科,江苏南京210009 [3]东南大学附属中大医院病案室,江苏南京210009 [4]东南大学附属中大医院消化科,江苏南京210009

出　　处：《实用放射学杂志》2004年第4期322-326,共5页Journal of Practical Radiology

摘　　要：目的　研究ERCP结合憩室造影对Lemmel’ssyndrome的诊断价值。方法　对经ERCP内镜直视下证实的 3 9例十二指肠乳头旁憩室 (periampullarydiverticula ,PAD)病人行常规ERCP后加做PAD造影 (改进ERCP) ,评估其对PAD的检出率及PAD对胆胰管末端压迫程度的显示能力 ,对结果行观察者间一致性分析。并对PAD的胆胰系合并症进行临床分析。结果　 3 9例病人发现 40个PAD ,位于乳头上方 2 6例 ,下方 4例 ,憩室内乳头 4例 ,憩室缘乳头 6例。 3 9例常规ERCP摄片显示憩室 9例 ;ERCP结合憩室造影摄片显示憩室 3 6例。 2种检查方法对PAD的检出率分别为 2 3 .0 8%、92 .3 1% ,差异具有统计学意义 ( χ2 test,Ρ <0 .0 0 1)。ERCP结合憩室造影在评判压迫程度的结果上 ,两阅片者间一致率 (Kappl值 )为 0 .718(k系数检验 ,Ρ <0 .0 1)。 2种方法显示憩室明显压迫胆胰管末端 ,从影像学上提示可能为乳头旁憩室综合征的例数比分别为 6/3 9( 15 .4% )、12 /3 9( 3 0 .8% )例。结论　ERCP结合PAD造影综合了ERCP和胃肠造影的优点 ,在一次检查中能清晰显示憩室、胆胰管及二者的解剖关系 ,有利于判断乳头旁憩室与胆胰系病变的关系及提高乳头旁憩室综合征的确诊率 。Objective To evaluate the usefulness of ERCP combined with duodenal diverticulography compared with conventional ERCP in the diagnosis of Lemmel's syndrome. Methods 39 patients with periampullary diverticula (PAD) proved by endoscopy were analysed.All cases were examined respectively by ERCP combined with and without divertivulography. The values of these examinations in evaluating the pancreaticobiliary tract system, PAD and their anatomic relationship were assessed. The k statistic was used to measure inter-observor agreement on the imaging of Lemmel's syndrome.Results In 39 patients, there were 40 PADs ,of which 26 PADs located above the papilla, 4 located below papallia, 4 were papallia in diverticula, 6 located in the neck edge of diverticula.The diverticula were showed in 9 cases and 36 cases by ERCP and ERCP combined with diverticulography respectively.The detecting rate of PAD by both examinations was 23.08% and 92.31% respectively,which was of statistical significance(χ 2test,Ρ<0.001) . The k values of interobservor agreement between the two observors on the improved ERCP technique were 0.718(k coefficient test, Ρ<0.01), that indicated a good agreement. Conclusion ERCP combined with duodenal diverticulography is of advantages which are provided with both conventional ERCP and barium study, it is a useful method to reveal the anatomic relationship of PAD to the lower end of CBD, and has a higher value in the diagnosis of Lemmel's syndrome than that of conventional ERCP.

关 键 词：ERCP 憩室造影 乳头旁憩室综合征 诊断 X线摄影 

分 类 号：R574.51[医药卫生—消化系统] R814.43[医药卫生—内科学]