内镜超声及磁共振胰胆管造影对可疑肝外胆管结石的诊断价值分析

Evaluation of magnetic resonance cholangiopancreatography and endoscopic ultrasonography in the diagnosis of suspected choledocholithiasis

目的评估内镜超声(EUS)及磁共振胰胆管造影(MRCP)在可疑肝外胆管结石中的诊断价值。方法选取中国医科大学附属盛京医院术前腹部超声及CT均未能确诊的肝外胆管结石病人111例,对其EUS及MRCP诊断结果进行对比分析。结果 EUS对胆管结石的敏感度(89.2%)高于MRCP(75.7%)(P<0.05),而特异度及准确率二者相比差异无统计学意义(P>0.05)。EUS对胆管末端及直径≤0.5 cm的胆管结石阳性预测值(82.14%)亦高于MRCP,差异具有统计学意义(P<0.05)。两种检查手段联合应用敏感度为95.95%。结论 EUS对胆管结石诊断更有优势,对胆管末端结石敏感度较高;MRCP对胆道树成像良好,可提供客观影像以辅助手术治疗,对胆道结构紊乱的病例价值更高;对其他影像检查诊断不清的疑似病例,两种检查联合应用可进一步降低漏诊率。

Objective To evaluate the clinical value of magnetic resonance cholangiopancretography and endoscopic uLTrasonography in the diagnosis of suspected choledoeholithiasis. Methods The clinical data were collected from 111 patients who were suspected with choledocholithiasis but not confirmed by transabdominal ultrasound and CT from July 2013 to July 2015 in Department of General Surgery, Shengjing Hospital of China Medical University.The result of MRCP and EUS were evaluated and compared. Results Compared with MRCP, EUS had obvious advantages in the sensitivity（89.2% vs. 75.7%, P 〈 0.05）, but no obvious difference in the specificity or accuracy （P 〉 0.05 ）. For the distal bile duct stones and those diamter no more than 0.Scm, the positive predictive value of EUS was higher than that of MRCP （P〈0.05）. The sensitivity of EUS combined with MRCP was 95.95%. Conclusion In the diagnosis of choedocbolithiasis,EUS is better than MRCP,especially for the microlith at the end of biliary.MRCP has better bile duct structure imaging.For those complicated suspected cases, EUS combined with MRCP could reduce the missed diagnosis rate furtherly.