胆总管结石应用CT、MRCP和超声内镜诊断的临床价值对比研究

Comparison of Clinical Value of CT, MRCP and Endoscopic Ultrasonography in the Diagnosis of Choledocholithiasis

目的探讨体层摄影(CT)、磁共振胰胆管成像(MRCP)与超声内镜(EUS)应用于胆总管结石的诊断效果。方法回顾性分析114例B超疑似胆总管结石患者临床资料,根据后续检查方法选择分为CT组(n=37)、MRCP组(n=45)与EUS组(n=32)。以内镜逆行胰胆管造影(ERCP)为"金标准",分析三组检查方法与ERCP的一致性及诊断符合率差异。结果三组经ERCP确诊胆总管结石比率分别为54.05%(20/37)、57.78%(26/45)、65.62%(21/32),组间比较差异无统计学意义(P>0.05)。三组诊断胆总管结石符合率分别为85.00%(32/37)、88.46%(41/45)、93.75%(30/32),组间比较无统计学意义(P>0.05),且在诊断胆总管结石方面与ERCP一致性均属良好(Kappa>0.70)。结论CT、MRCP及EUS诊断胆总管结石效能均较高,临床可根据实际情况进行灵活选择。

Objective To explore the diagnostic effects of computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) in the diagnosis of choledocholithiasis.Methods The clinical data of 114 patients which suspected as choledocholithiasis by ultrasound were analyzed retrospectively. The patients were divided into CT group (n=37),MRCP group (n=45) and EUS group (n=32) according to the follow-up examination methods.Endoscopic retrograde cholangiopancreatography (ERCP) was used as the gold standard to analyze the consistency and diagnostic coincidence rate of the three groups.Results The choledocholithiasis ratios diagnosed by ERCP in the three groups were 54.05%(20/37),57.78%(26/45) and 65.62%(21/32) respectively (P>0.05).The coincidence rates of the three groups in the diagnosis of choledocholithiasis were 85.00%(32/37),88.46%(41/45) and 93.75%(30/32) respectively (P>0.05),and they were well consistent with ERCP in the diagnosis of choledocholithiasis (Kappa>0.70).Conclusion CT,MRCP and EUS have ideal efficacy in the diagnosis of choledocholithiasis,and the method can be flexibly selected for patients in clinical practice.