超声对肝外胆管梗阻的病因诊断价值

Value of ultrasound in etiological diagnosis of extrahepatic biliary obstruction

目的探讨超声对肝外胆管梗阻性疾病的病因诊断价值。方法对我院2006-2007年收治并手术的91例肝外胆管梗阻性疾病患者的超声声像图进行回顾性分析和总结,并与手术病理结果对比分析,总结不同病因引起肝外胆管梗阻的超声影像特点,从而提高超声诊断率。结果91例肝外胆管梗阻性疾病患者的超声病因诊断总符合率89.0%(81/91),其中胆管结石符合率94.7%(54/57),胰腺炎符合率66.7%(2/3),胆管炎符合率66.7%(2/3),胰头癌符合率84.6%(11/13),壶腹部癌符合率81.8%(9/11),胆管癌符合率75%(3/4)。误诊10例(10.9%),分别为胆管结石3例,胰腺炎与胆管炎各1例,胰头癌与壶腹部癌各2例,胆管癌1例。结论超声对肝外胆管梗阻的病因诊断与手术病理结果符合率高,具有较高的病因诊断价值,可作为肝外胆管梗阻性疾病检查的首选方法。

Objective To investigate the value of ultrasound in etiological diagnosis of extrahepatic biliary obstruction. Methods Ninety-one patients with extrahepatic biliary obstruction operated in Tenth People＇ s Hospital from 2006 to 2007 had been examined by ultrasound. The imagines were analyzed retrospectively and the etiological diagnosis was compared with the results of pathology after surgery in order to improve the accuracy of ultrasound diagnosis. Results The total diagnostic coincidence rate was 89.0% （ 81/91 ）. In all 91 cases, extrahepatic biliary calculi coincidence rate was 94.7% （54/57）, pancreatitis coincidence rate was 66.7 % （2/3）, inflammation of biliary coincidence rate was 66.7 % （2/3）, carcinoma of head of pancreas coincidence rate was 84. 6% （11/13）, ampullary carcinoma coincidence rate was 81. 8% （9/11） and carcinoma of bitiary coincidence rate was 75 % （3/4）. Ten cases were misdiagnosed of which 3 cases were extrahepatic biliary calculi, 1 case was pancreatitis, 1 case was inflammation of biliary, 2 cases were carcinoma of head of pancreas, 2 cases were ampullary carcinoma, 1 case was carcinoma of biliary. Conclusion Ultrasound has high diagnostic coincidence with the results of pathology. It is certainly valuable as the first choice for etiological diagnosis of extrahepatic biliary obstruction.