ERCP、CT、B超对胰胆管下段疾病的诊断准确性

Accuracy of ERCP,CT and ultrasound for diagnosing benign and malignant lesions of low segmental cholangiopancreatic duct

目的比较ERCP、CT、B超对胰胆管下段疾病的诊断准确性。方法100例临床表现为梗阻性黄疸,反复上腹痛、恶心呕吐的患者均经ERCP、CT及B超检查。本组患者经手术病理或活检证实为良性病变(胆总管结石)57例,恶性肿瘤32例,其中胆总管癌11例,胰头癌13例,以及壶腹癌8例。上述3种方法术前的定性诊断准确率均与手术病理结果对照。结果对胆总管结石的定性诊断准确率:ERCP为98%(n=56),CT为72%(n=41),B超为61%(n=35);对恶性肿瘤的定性诊断准确率:ERCP为97%(n=31),CT为78%(n=25),B超为63%(n=20)。结论ERCP对胰胆管下段良恶性病变的定性诊断准确率明显高于CT和B超,但因CT与B超均属无创性操作且对某些恶性肿瘤也有较高的定性诊断准确率,因此在影像诊断中应考虑3项技术优势互补。

Objective To compare the accuracy between ERCP,CT and ultrasound (US) for diagnosing the benign and malignant lesions of lower segmental cholangiopancreatic duct.Methods A hundred patients with clinically presented obstructive jaundice,repeated upper abdomen pain,nousea and vomiting underwent EPCP,CT and US examinations.Among all patients,surgery and pathology or biopsy demonstrated 57 cases of benign lesions (calculus of common bile duct) and 32 cases of malignant tumors(11 carcinoma of common bile duct,13 carcinoma of pancreatic head and 8 ampullary carcinoma).The accuracy of above 3 kinds of techniques in the qualitative diagnosis was compared with surgical and pathological findings.Results For the accuracy of qualitative diagnosis in benign lesions (calculus of common bile duct),ERCP was 98 %(n=56),CT was 72 %(n=41),and US was 61 %(n=35),that in mlignant lesions ERCP was 97 %(n=31),CT was 78 %(n=25)and US was 63 %(n=20).Conclusion The accuracy of ERCP in the qualitative diagnosis of benign and malignant lesions of lower segmental cholangiopancreatic duct is significantly higher than that of CT and US.However because CT and US are referred to non-invasive procedures and has higher accuracy for diagnosing some malignant tumors(for example,carcinoma of common bile duct and carcinoma of pancreatic head)and therefore when selecting imaging diagnosis We should consider the complementary avantages of ERCP,CT and US.