结合ERCP与螺旋CT三维成像对阻塞性黄疸的诊断价值

Diagnosis of Cholangetic Jaundice by Combined ERCP and Three-dimensional Spiral CT Cholangiography

目的 :探讨对阻塞性黄疸更精确的影像学诊断方法。方法 :对 45名怀疑有阻塞性黄疸的病人 ,行常规ER CP检查 ,退镜后立即进行螺旋CT扫描。将螺旋CT三维成像显示胆管阻塞的原因、位置和程度与ERCP的检查结果相比较。结果 :45名病人中 ,螺旋CT胆管造影显示了 30名病人有胆管阻塞 ,没有假阳性或假阴性病例。胆管阻塞的原因有 :胆管结石 2 4例、胆管癌 3例、胆管狭窄 3例。ERCP与螺旋CT胆管造影均能对 2 4例胆管结石的位置、大小作出正确评价。对 2名胆管癌的病人 ,螺旋CT胆管造影描绘了未显影的部位 ,而ERCP却未能作到。螺旋CT胆管造影未能对 1名病人的胆管狭窄长度作出正确评价。ERCP对 2名病人肝内胆管狭窄有更清晰的诊断。结论 :ERCP结合螺旋CT三维成像对怀疑有阻塞性黄疸病人的胆管系统可作出正确评价。

Purpose: To investigate more precise method of iconography to diagnose cholangetic jaundice. Methods: After endoscopic retrograde cholangiography (ERCP), 45 patients with suspected cholangetic jaundice underwent upper abdominal spiral CT with subsequent three dimensional redering of the biliary tract. The reason, site and extent of biliary obstruction were compared with that at ERCP. Results: Spiral CT cholangiography correctly depicted biliary obstruction in 30 of 45 patients,with no false positive of false negative case. The reason of biliary obstruction: bile duct stone 24 cases, cholangiocarcinoma 3 cases, bile duct stenosis 3 cases. In 24 patients, the site and size of bile duct stone could be assessed with spiral CT cholangiography and ERCP. In two patients with cholangiocarcinoma, spiral CT cholangiography depicted undrained areas not seen with ERCP. In one patients, ERCP give the more precise diagnosis of intrahepatic bile duct stenosis. Conclusion: Combined ERCP and spiral CT cholangiography allow accurate assessment of the biliary system in patients with suspected cholangetic jaundice.