不同影像检查方法诊断胆总管结石的比较研究

Contrast research of different imaging diagnostic methods on choledocholithiasis

目的评价超声、多层螺旋CT(MSCT)、磁共振胆胰管成像(MRCP)、内镜逆行性胰胆管造影(ERCP)对胆总管结石的诊断价值。方法回顾分析在我院疑诊为胆总管结石的患者,选取同时行B超、MSCT及MRCP的94例患者,以ERCP相关治疗或手术为诊断胆总管结石的"金标准"进行统计分析。选取术前行MRCP检查,并经ERCP检查及治疗证实为胆总管结石的患者共65例,按结石大小分组统计比较MRCP、ERCP的诊断率。结果 B超、MSCT、MRCP诊断胆总管结石的敏感度分别为63.3%、74.7%、87.3%,特异度分别为53.3%、80.0%、86.7%,准确度分别为61.7%、75.5%、87.2%;2检验显示准确度由高到低分别为MRCP、MSCT、B超。分析不同大小的结石:MRCP独立诊断时三组结石准确度之间差异有统计学意义,对直径0.5cm及以下的微小结石显示不佳(P<0.05);ERCP独立诊断时三组准确度之间差异没有统计学意义;各组结石分别同时用MRCP与ERCP诊断,两种检查方法之间的准确度均没有统计学意义。结论 B超和MSCT诊断胆总管结石有一定的局限性,可作为胆总管结石首选的筛查方法,尤其是急诊患者;MRCP安全、无创伤,在一定程度上可以替代诊断性ERCP;ERCP对胆总管结石的诊疗方面具有较大临床优势。

Objective To evaluate ultrasound（US）,MSCT,MRCP and ERCP in the diagnosis of choledocholithiasis.Methods We retrospectively analysed the materials of patients who were suspected with CBDS in our hospital during January 2010 to December 2011.A total of 94 patients who were diagnosed with US,MSCT and MRCP were selected,and the acquired results were compared with the final results.The diagnostic accuracy was calculated respectively.A total of 65 choledocholithiasis patients who used MRCP and ERCP were selected for diagnosis before operative,and statistic was conducted to compare diagnosis accuracy according to the size of the stone group.Results The sensitivity in detecting choledocholithiasis for US,MSCT and MRCP were 63.3%,74.7%,87.3%,the Specificity were 53.3%,80.0%,86.7%,and the overall diagnotic accuracy were 61.7%,75.5%,87.2% respectively.According to accuracy from high to low using x2 examination,they were MRCP,MSCT and US.Statistics showed significant differences between three groups using MRCP（P=0.000）.The accuracy of diagnosing microlithiasis in the common bile duct using MRCP was quite low.It was not statistically significant between three groups using ERCP（P=0.073）.In each group of stones,the accuracy between two methods was not statistically significant.Conclusion They had some limitations using US and MSCT to diagnose choledocholithiasis,and they could be used as the first choice of choledocholithiasis,especially emergency patients.To a certain extent,MRCP can replace diagnostic ERCP.It has great clinical advantage using ERCP to diagnose and treat choledocholithiasis.