磁共振胰胆管成像在胆石病患者术前评估中的临床价值

Clinical value of magnetic resonance cholangiopancreatography in the preoperative evaluation of patients with biliary calculus

目的：探讨磁共振胰胆管成像（MRCP）在胆石病患者术前评估中的临床价值。方法回顾性分析2012年6月至2013年6月中山大学孙逸仙纪念医院和中山大学附属第三医院收治的70例胆石病患者临床资料。其中男38例,女32例；年龄18～87岁,中位年龄52岁。所有患者均签署知情同意书,符合医学伦理学规定。患者术前先后进行超声检查及MRCP ,手术方式为胆囊切除＋胆道探查术,以术中探查结果为诊断结石和胆道变异的金标准。两种方法对胆管结石和胆道变异检出率的比较采用χ2检验和Fisher确切概率法。结果超声检查对胆囊结石的检出率为93%（62/67）, MRCP为79%（53/67）,差异有统计学意义（χ2=4.968, 〈0.05）。超声检查对胆总管结石的检出率为61%（17/28）, MRCP为86%（24/28）,差异有统计学意义（χ2=4.462, 〈0.05）。超声检查对肝左、右管结石的检出率为2/5, MRCP为4/5,差异无统计学意义（P〈0.05）。超声检查对肝内胆管结石的检出率为36%（4/11）, MRCP为73%（8/11）,差异无统计学意义（P〈0.05）。超声检查对胆道变异的检出率为2/8, MRCP为7/8,差异有统计学意义（p〈0.05）。结论 MRCP在胆总管结石和胆道变异检出方面优于超声检查,有条件时可作为胆石病患者术前常规评估方法。

Objective To investigate the clinical value of magnetic resonance cholangiopancreatography （MRCP） in the preoperative evaluation of patients with biliary calculus. Methods Clinical data of 70 patients with biliary calculus in Sun Yat-sen Memorial Hospital and the Third Afifliated Hospital of Sun Yat-sen University from June 2012 to June 2013 were retrospectively analyzed. There were 38 males and 32 females with age ranging from 18 to 87 years old and the median age of 52 years old. The informed consents of all patients were obtained and the ethical committee approval was received. The patients underwent ultrasound examination and MRCP before operation. The surgical procedures were cholecystectomy＋bile duct exploration and the intraoperative exploration result was the gold standard of diagnosis for biliary calculus and biliary tract variations. The detectable rate of biliary calculus and biliary＆amp;nbsp;tract variations by two methods were compared using Chi-square test and Fisher＆#39;s exact probability test. Results The detectable rate of gallstones was 93%（62/67） by ultrasound and was 79%（53/67） by MRCP, where signiifcant difference was observed （χ2=4.968, P〈0.05）. The detectable rate of common bile duct stones was 61%（17/28） by ultrasound and was 86%（24/28） by MRCP, where signiifcant difference was observed （χ2=4.462, P〈0.05）. The detectable rate of the left and right hepatic duct stones was 2/5 by ultrasound and was 4/5 by MRCP, where no signiifcant difference was observed （P＆gt;0.05）. The detectable rate of intrahepatic bile duct stones was 36%（4/11） by ultrasound and was 73%（8/11） by MRCP, where no signiifcant difference was observed （P＆gt;0.05）. The detectable rate of biliary tract variations was 2/8 by ultrasound and was 7/8 by MRCP, where signiifcant difference was observed （P〈0.05）. Conclusions MRCP is superior to ultrasound examination in the detection of common bile duct stones and biliary tract variations. It can be a common practice in the preoperative evaluation of patients with biliary calculus when circumstances allow.