腹部B超 CT和超声内镜对不同临床分期慢性胰腺炎诊断价值比较

Comparison among abdominal B-ultrasonography, computed tomography and endoscopic ultrasonography in diagnosis of chronic pancreatitis with different classifications

目的比较腹部B超、腹部CT和超声内镜(EUS)对不同临床分期慢性胰腺炎(CP)的诊断价值。方法回顾性分析2001年1月至2011年9月在北京协和医院确诊的84例CP患者的临床资料,采用卡方检验连续校正、Fisher精确概率检验及相关样本卡方检验(Mc Nemar检验)进行分析。结果腹部B超诊断阳性率为55.95%,CT诊断阳性率为66.67%,EUS诊断阳性率为72.62%,EUS诊断阳性率高于腹部B超(P=0.016),与CT检查相似(P=0.383)。腹部B超、CT、EUS对1、2期CP诊断阳性率差异无统计学意义(P>0.05)。而在3期CP诊断中,EUS要优于腹部B超(P<0.05),而与CT相比差异无统计学意义(P>0.05)。胰腺萎缩、假性囊肿在临床2期发生率明显高于1期(P<0.05)。结论影像学检查对于CP临床新分期具有一定价值,腹部B超可以作为影像学检查手段之一,但对于早期胰腺炎几个影像学检查差异无统计学意义,对于辨识不清的影像可考虑EUS检查。

Objectives To evaluate the efficacy of abdominal B-ultrasonography （BUS）, computed tomography （CT） and endoscopic ultrasonography （EUS） in the diagnosis for different dassifications of chronic pancreatitis （CP）. Methods The clinical data of patients diagnosed with CP by Peking Union Medical College Hospital from January 2001 to September 2011 were analyzed retrospectively. Statistical methods included chi-square test with continuous correction, Fisher exact test and matched-pairs chi-square test （McNemar test）. Results （1） The study population contained 66 males and 18 females, with a mean age of 50 years. （2） The sensitivities of abdominal BUS, CT and EUS were 55.95%, 66.67% and 72.62%, respectivelF EUS was superior to BUS （P=0.016）, and consistent with CT （P=0.383）. （3） The sensitivities of different imaging methods in the diagnosis of stage-1 or -2 CP had no significant differences （P〉0.05）. As for stage-3 CP, EUS was superior to abdominal BUS （P〈0.05） and consistent with CT （P〉0.05）. （4）. Pancreatic atrophy and pseudocysts were more common in stage-2 CP than stage-1 one （P〈0.05）. Conclusion Imaging methods are helpful in the diagnosis of CP with new clinical classifications. Abdominal BUS may be proposed as the first-line imaging method. EUS may be considered for further differential diagnoses..