肝门胆管狭窄的病因分析与影像学诊断的临床评价

Etiological analysis of bile duct obstruction in porta hepatis and clinical evaluation of imaging diagnostic technique

目的:总结分析肝门胆管狭窄的病因并探讨各影像学诊断方法在肝门胆管狭窄疾病中的诊断符合率.方法:回顾分析我院及山西医科大学第二医院于1982-200482例资料完整的肝门胆管狭窄患者的主要病因以及超声(US)、磁共振胰胆管造影(MRCP)、逆行胰胆管造影(ERCP)、经皮肝穿胆道造影(PTC)等影像诊断结果,分析各项影像技术在肝门胆管狭窄诊断中的适应症和诊断符合率.结果:恶性病变占肝门胆管狭窄病的87.80%,其中大部分由肝门胆管癌引起,占总例数的76.83%,其次胆囊癌占7.32%,结肠癌肝门转移1.22%,肝细胞癌并发癌栓2.44%等.良性病变占12.2%,主要为损伤性胆管、胆管囊肿、硬化性胆管炎以及胆管结石等.US,ERCP,PTC,MRCP对肝门胆管狭窄的诊断准确率分别为84.15%,92.86%,100%,100%.结论:恶性病变是肝门部胆管狭窄病的主要原因,良性病变相对比例较小.在肝门胆管狭窄的诊断中,影像学诊断技术扮演着关键辅助作用的角色,能协助临床迅速获得准确结论.

AIM： To summarize the causes of bile duct stricture in porta hepatis and probe into the diagnostic values of imaging techniques. METHODS： The data of 82 patients with bile duct stricture in porta hepatic were collected, and the causes of the disease were analyzed, and the application and diagnostic coincidence rate of imaging techniques such as ultrasonography （US）, magnetic resonance cholangiopancreatography （MRCP）, endoscopic retrograde cholangiopan- creatography （ERCP）, percutaneous transhepatic cholangiography （PTC） were calculated. RESULTS： The malignant stricture accounted for 87.80% of the bile duct strictures in porta hepatis, among which the majority was caused by bile duct cancer in porta hepatis, occupying 76.83% of the total; Secondly, the rate of gallbladder cancer was 7.32%, porta hepatis metastasis of colon cancer and tumor thrombus of hepatocellular carcinoma were 1.22% and 2.44%, respectively. Benign causes accounted for 12.20%, including common bile duct cyst, injured bile duct, primary sclerosing cholangitis, and bile duct calculi. The coincidence rates of US, ERCP, PTC, and MRCP in the diagnosis of bile duct stricture in porta hepatis were 84.15%, 92.86%, 100%, and 100%, respectively. CONCLUSION： The malignant disease is the main cause of bile duct stricture in porta hepa- tis. Meanwhile, imaging techniques can help to make accurate diagnosis of this disease.