ERCP联合胆道微结石检查在急性胆管炎中的诊断价值

Clinical Application of ERCP and Biliary Microlithiasis Exploration in Acute Cholangitis

目的探讨ERCP联合胆道微结石检查在即性胆管炎中的临床价值。方法对于54例急性胆管炎患者,常规行B超、CT或MRCP检查,经ERCP或ENBD收集患者的胆汁,通过普通和偏光显微镜查找微结石。结果54例患者常规检查(B超、CT或MRCP)提示36例胆总管结石或扩张,18例无明显异常。54例患者均行ERCP,其中5例急诊行ENBD治疗,3例ERCP插管失败;ERCP提示35例胆总管结石,4例胆总管下端炎性狭窄,12例未见明显异常;在12例无明显异常的患者中,9例在偏光显微镜下检测有胆道微结石(大多为胆固醇单水结晶)。与常规检查组、ERCP组比较,联合检查组大大提高了结石阳性检出率,统计学比较具有显著性差异(P<0.05)。结论ERCP联合镜下查找微结石可以提高胆道结石的诊断率;不明原因的急性胆管炎与胆道微结石密切相关。

Objective： To study on the clinical application of ERCP combined with micmlithiasis exploration in acute cholangitis. Methods： The clinical data of consecutive 54 cases of acute cholangitis were analyzed. Before ERCP, all cases were examined by routine examinations, including abdominal ultrasonography computer tomography （CT） or magnetic resonance cholangiopancreatography （MRCP）.To collect the bile through endoscopic retrograde cholangiopancreatography （ERCP） or endoscopic nasobiliary drainage （ENBD）, then all the samples were checked by polarization microscope. Results： 36 cases out of 54 patients with common bile duct （CBD） stones or dilation of common bile duct were diagnosed by routine examination. ERCP was performed in all patients, only 3 cases failed, and the rest were successful,Through ERCP, 35 cases with CBD stones, 4 cases with CBD inflammatory stricture were diagnosed; 12 cases were normal. Among the 12 cases, 9 cases were conformed with biliary microlithiasis by polarization microscope.The diagnostic effectiveness of ERCPcombined with microlithiasis exploration was highest, and there was significant difference among them （P〈0.05）. Conclusion： It may improve the diagnostic accuracy to combine ERCP with biliary micmlithiasis exploration in CBD stones; Biliary microlithiasis may play an important role in the pathogenesis in acute unexplained cholangitis.