胆管扩张声像特征在梗阻性胆管疾病鉴别诊断中的意义

Ultrasonographic characteristics of cholangiectasis in differential diagnosis of diseases of bile duct obstruction

目的探讨胆管扩张声像特征在梗阻性胆管疾病(DBDO)鉴别诊断中的意义。方法164例DBDO患者分为4组:胆管结石组(n=52)、胆管癌组(n=56)、胆管囊状扩张症组(n=32)和胆管乳头状瘤组(n=24)。将胆管扩张声像表现分为规则型、不规则型、囊状扩张型和胆汁湖型,比较各组胆管扩张最大内径平均值以及各组胆管扩张类型所占的比例。结果164例DBDO患者超声诊断准确率为98.17%(161/164)。胆管结石组和胆管癌组胆管扩张内径分别与胆管囊状扩张症组与胆管乳头状瘤组比较差异均有统计学意义(P均<0.01);胆管囊状扩张症组胆管扩张内径与胆管乳头状瘤组比较差异亦有统计学意义(P<0.01)。胆管结石组胆管扩张规则型(34/52,65.38%)、胆管癌组胆管扩张不规则型(47/56,83.93%)、胆管囊状扩张症组胆管囊状扩张型(26/32,81.25%)以及胆管乳头状瘤组胆管扩张呈胆汁湖型(20/24,83.33%)所占比率分别与其他各组比较差异均有统计学意义(P均<0.01)。结论胆管扩张的不同声像特征在DBDO的鉴别诊断中具有重要的临床意义。

Objective To probe the significance of ultrasonographic characteristics of cholangiectasis in differential diagnosis of the diseases of bile duct obstruction（DBDO）.Methods A total of 164 patients with DBDO were divided into 4 groups： bile duct calculi（n=52）,cholangiocarcinoma（n=56）,cystic dilatation of biliary duct（n=32） and bile duct papilloma（n=24）.The ultrasonographic characteristics of cholangiectasis were classified as regular type,abnormal type,cystic dilated type and bile lake type.The average value of the largest diameter of the bile duct（DBD） and the percentage of each type of the cholangiectasis of each group were compared.Results The accuracy of ultrasound for the diagnosis of 164 DBDO was 98.17%（161/164）.DBD of both bile ducts of calculi and cholangiocarcinoma were different from that of cystic dilatation of biliary duct and bile duct papilloma,respectively（P〈0.01）,as well as between cystic dilatation of biliary duct and bile duct papilloma（P〈0.01）.The percentage of regular type of cholangiectasis in bile duct calculi（65.38%,34/52）,abnormal type in cholangiocarcinoma（83.93%,47/56）,cystic dilated type in cystic dilatation of biliary duct（81.25%,26/32） and bile lake type in bile duct papilloma（83.33%,20/24） was different from those of others,respectively（P〈0.01）.Conclusion Different ultrasonographic characteristics of cholangiectasis has important clinical significance in the differential diagnosis of DBDO.