B超、MRCP、ERCP诊断胆总管结石的对比分析

A comparative analysis of ultrasonography,MRCP and ERCP for diagnosing common bile duct stones

目的探讨B超、磁共振胆胰管成像(MRCP)、内镜逆行胰胆管造影术(ERCP)对胆总管结石的诊断价值。方法收集我院2007年4月至2010年9月胆总管结石患者214例,以内镜下十二指肠乳头括约肌切开术取出结石为诊断标准,对B超、MRCP、ERCP3种检查方法进行对比分析。结果 ERCP诊断胆总管结石的敏感性为99%,显著高于MRCP的90%,差异有统计学意义(χ2=15.58,P<0.01);MRCP的敏感性亦明显高于B超(38.5%),差异有统计学意义(χ2=115.4,P<0.01)。B超、MRCP、ERCP诊断胆总管结石的特异性分别为92.8%、92.9%、100%,3种诊断方法比较差异无统计学意义。MRCP诊断胆总管结石的准确性为93.3%,显著高于B超(85.6%),差异有统计学意义(χ2=4.37,P=0.037),但与ERCP(93.4%)比较差异无统计学意义(χ2=0.03,P=0.95)。结论 B超对于胆总管结石的诊断具有一定的准确率,可作为最基本的检查手段,MRCP和ERCP对于胆总管结石的诊断具有较高的一致性,MRCP可部分替代诊断性ERCP,ERCP具备诊断及治疗双重效果,地位不可替代。

Objective To evaluate the diagnostic value of type-B ultrasonic,magnetic resonance cholangiopancreatography（MRCP） and endoscopic retrograde cholangiophancreatography（ERCP） in common bile duct stones（CBDS）.Methods Two hundred and fourteen cases of in-patients diagnosed with CBDS from April 2007 to September 2010 were studied.The results of the three imaging technologies were compared and analyzed.The diagnosis in all cases were confirmed by finding of stones under endoscopic Sphinctero-Papillotomy（EST）.Results The sensitivity of ERCP was 99%,which was significantly higher than that of MRCP（90%）（χ2=15.58,P0.01）,and the difference in sensitivity between MRCP and type-B ultrasonic（38.5%） was also statistically significant（χ2=115.4,P0.01）.There was no significant difference in specificity among the three methods.The accuracy of MRCP in diagnosing CBDS was 93.3%,which was significantly higher than that of type-B ultrasonic（85.6%）（χ2=4.37,P=0.037）but not different from ERCP（93.4%）（χ2=0.03,P=0.95）.Conclusion Type-B ultrasonic demonstrated a certain degree of accuracy and remained as an initial imaging method for diagnosing CBDS.MRCP can partially substitute ERCP in diagnosing CBDS based on its high consistency.However,ERCP remained irreplaceable due to its vital value in both diagnosis and therapy of CBDS.