腹腔镜胆囊切除术前MRCP的应用价值分析

目的 讨论磁共振胰胆管成像(MRCP)在腹腔镜胆囊切除术(LC)前的应用价值.方法 分析本院2008年10月至2010年5月拟行LC、术前怀疑胆总管结石而行MRCP检查的56例患者的临床诊治资料.结果 经MRCP检查发现胆总管结石15例,均成功行EST+LC术.未发现胆总管结石的41例仅行LC术,术后3例出现胆管炎表现,经ERCP证实胆总管结石,行EST取石.结论 腹腔镜胆囊切除术前,对于可疑伴有胆总管结石的胆囊结石患者,MRCP检查具有重要的诊断价值,同时可根据MRCP检查结果,选择不同的微创治疗方法.     

531例阻塞性黄疸的四种影像学检查分析

目的 探讨超声(B超)、腹部CT、磁共振胰胆管成像(MRCP)和经内镜逆行胰胆管造影(ERCP)四种检查方法对梗阻性黄疸(以下简称阻黄)的诊断价值,为阻黄患者影像学合理检查的选择提供依据.方法 回顾性分析2004-2008年期间经手术确诊的531例阻黄患者的术前B超、CT、MRCP、ERCP四种影像学检查结果,将四种影像学检查的结果与术后诊断比较.结果 B超、CT、MRCP、ERCP总的术前受检率分别为100.00%、20.90%、63.28%、24.29%.其诊断准确率分别为77.97%、89.19%、94.64%、97.67%.CT、MRCP、ERCP三种检查的诊断符合率较B超高,p值均小于0.001;MRCP、ERCP的诊断符合例数和符合率与CT比较以及ERCP与MR-CP的诊断符合例数和符合率比较,统计学上无差异.结论 由于B超具有经济、简便、安全、无创、可重复等优点,所以可以作为阻黄患者术前的首选影像学检查;CT、MRCP及ERCP对阻黄的诊断均具有更高的价值,其中MRCP首选.     

内镜下逆行胰胆管造影术诊疗分析

目的 了解内镜下逆行胰胆管造影术(ERCP)临床运用价值.方法 分别运用日本Olympus JF-10及JF-140R电子十二指肠镜及相关仪器对116例胆道疾病患者行ERCP术,观察术中及术后情况,并将其检查结果与手术结果对照.结果 ERCP诊断准确率94.8%,无一例出现严重并发症.结论 ERCP是明确乳头壶腹癌和继发性Oddi's括约肌功能紊乱的病因诊断的首选方法.其对梗阻性黄疸的病因诊断率明显优于B超和CT,在早期诊断胆管癌方面明显优于B超及CT检查,为诊断胆管癌最佳方法.     

磁共振胰胆管成像在梗阻性黄疸诊断中的应用

目的 评价磁共振胰胆管成像（MRCP）对梗阻性黄疸梗阻部位及原因的诊断价值。方法 对36例梗阻性黄疸患者行MRCP检查,所有患者均经手术及病理证实。结果 MRCP对梗阻性黄疸梗阻部位诊断正确率为100％,梗阻原因诊断正确率为66．7％,MRCP结合MRI诊断正确率达80．6％,各类病变均具有其特征性表现。结论 MRCP图像质量高,不需造影剂,无相关并发症,故对梗阻性黄疸的诊断安全可靠,MRCP结合MRI可有效提高对梗阻性质判断的准确性。     

磁共振胰胆管成像与经内镜逆行胰胆管造影对胆胰疾病诊断价值的比较研究

目的 评价磁共振胰胆管成像(MRCP)与经内镜逆行胰胆管造影(ERCP)对胆胰疾病的诊断价值.方法 对134例怀疑为胆胰管疾病病人行MRCP,并与58例ERCP比较,所有病例均经手术病理证实.结果 134例MRCP均获成功,在行ERCP中54例成功,4例失败者改行PTC检查成功.MRCP和ERCP总的诊断准确率分别为90.3%和88.9%.结论 MRCP对胆胰系统疾病中恶性梗阻所致的梗阻性黄疸诊断准确性较高,对胆总管、肝内胆管较小结石的诊断不如ERCP敏感及准确,而且不能治疗,提示MRCP和ERCP各有优越点,二者合理应用可提高胆胰系统疾病的诊断符合率.     

磁共振胰胆管造影与内窥镜逆行胰胆管造影对胰腺炎诊断价值的比较

目的 评价磁共振胰胆管造影（MRCP）对胰腺炎诊断的应用价值。方法 回顾性分析39例胰腺炎患者的MRCP图像,并与内窥镜逆行胰胆管造影（EPCP）的图像相比较。结果 对所得的196段胰胆管MRCP图像进行分析,17段显影不清（敏感度为91%）,14段显影不准确（准确率为92%）。MRCP成像对轻微狭窄或扩张的胆胰管显示不具特征性,只有2例由于人工伪影造成MRCP显影不满意。结论 MRCP与ERCP对胰腺炎的诊断有相同的应用价值。在患者不能耐受ERCP检查或ERCP检查失败的情况下,MRCP可代替ERCP检查。     

选择性应用MRCP防止LC术后胆总管结石的残留

目的 探讨选择性应用MRCP在LC术前的临床诊断价值.方法 回顾性分析我院2008年2月至2010年2月206例择期行LC术患者的临床资料,134例在LC术前选择性行MRCP检查.结果 MRCP检查提示30例胆囊结石患者合并有胆总管下段结石.经手术证实,其中26例为并发胆总管结石,1例为胆总管解剖学变异,3例未发现胆总管结石.术后随访未发现胆总管结石漏诊报告.结论 LC术前选择性行MRCP检查能减少胆总管结石、胆道变异的漏诊.     

儿童胆总管囊肿51例ERCP分析

目的 了解儿童胆总管囊肿的分型、胆管胰管汇合方式与胆总管囊肿形态关系,及胆总管囊肿并发症发生率,探讨儿童胆总管囊肿ERCP检查的诊断价值. 方法 回顾分析1998年6月至2003年3月长海医院ERCP检查诊断儿童先天性胆总管囊肿51例图像及随访资料. 结果 成功行ERCP 45例,行逆行胆管造影(ERC)6例.胆总管囊肿分型,Ⅰ型41例,其中Ⅰ a 17例,Ⅰ b 10例,Ⅰ c 14例.Ⅳ型10例,其中Ⅳa 8例、Ⅳb 2例.合并胰胆管合流异常37例,占82.2%,合流方式为B-P型21例,P-B型16例.并选定Ⅰ c型为胆总管柱状扩张组;Ⅰ a+Ⅰ b+Ⅳ型均为囊状扩张组,对照分析,柱状扩张中P-B型占80%,囊状扩张中B-P型占70.4%.合并有胆道结石8例,胰管扩张2例.测量胰胆管合流异常共同管长度=0.5 cm 4例,>0.5cm且<1.5 cm 20例,≥1.5 cm 13例.14例随访病例中,未发现急性胰腺炎及出血、穿孔等严重并发症. 结论 儿童先天性胆总管囊肿Ⅰ型最多见,且大多数合并胰胆管合流异常.胆管柱状扩张中P-B型较常见,胆管囊状扩张中B-P型较常见.ERCP检查对儿童胆总管囊肿诊断安全有效.     

治疗性ERCP在胆胰疾病中的应用

目的 探讨治疗性经内镜逆行胰胆管造影(ERCP)在胆胰系统疾病中的治疗价值.方法 对2004年4月至2008年4月间我院收治的887例经ERCP治疗的病例资料进行回顾性分析,以评价治疗性ERCP在各种胆胰疾病中的应用价值.结果 治疗性ERCP成功率94.1%,治疗病例中胆管结石最多,占65.6%,其次为恶性胆道梗阻,占12.2%.急性胆源性胰腺炎占7.6%.胆道良性狭窄占5.0%,急性梗阻性化脓性胆管炎占5.0%,胆道术后胆漏占1.4%,慢性胰腺炎占1.8%.包括高淀粉酶血症在内的并发症发生率为7.7%,无严重并发症和死亡病例.结论 治疗性ERCP对多种胆胰疾病疗效确切,是一种安全有效的胆胰疾病微创治疗手段.     

磁共振胆胰管成像诊断胆道梗阻性疾病的价值

目的：结合临床探讨磁共振胆胰管成像技术（MRCP）在诊断胆道梗阻性疾病时的价值。方法：回顾性总结74例胆道梗阻性疾病患者MRCP检查结果，并结合临床进行对照分析。结果：MRCP对胆道梗阻性疾病的定位正确率97％；对良性胆道梗阻性疾病的定性诊断率82％，恶性胆道梗阻性疾病的定性诊断率85％。结论：MRCP对胆道梗阻性疾病有较高的定性和定性正确率，并可部分替代ERCP作用。     

ERCP在梗阻性黄疸诊治中的价值

目的：评价经内镜逆行胰胆管造影（ERCP）对梗阻性黄疸的诊治价值。方法：75例病因不确切梗阻性黄疸患者均行ERCP检查,并与MRCP对比分析ERCP诊治结果。结果：ERCP对梗阻性黄疸病因诊断符合率84.0%（63/75）,明显高于MRCP诊断符合率53.3%（40/75）,差异有统计学意义（P〈0.05）。ERCP、MRCP对胆系结石所致梗阻性黄疸诊断符合率分别为92.1%（35/38）、78.9%（30/38）,差异无统计学意义（P〉0.05）。对胆系结石以外的病因所致梗阻性黄疸,ERCP诊断符合率为80.0%（28/35）,明显高于MRCP28.6%（10/35）,差异有统计学意义（P〈0.01）。10例胆总管结石患者在ERCP下取石成功。结论：在明确梗阻性黄疸病因方面的作用,目前MRCP尚不能取代ERCP。ERCP对于部分梗阻性黄疸患者具有一定治疗作用。     

MRCP与ERCP对低位梗阻性黄疸诊断价值的比较

目的 评价磁共振胰胆管造影术(MRCP)和内窥镜逆行胰胆管造影(ERCP)在低位梗阻性黄疸中的诊断价值.方法 将78例经B型超声证实为低位梗阻性黄疸的病人随机分为2组(均无禁忌证),其中1组40例行MRCP检查,另1组38例行ERCP检查.通过对比检查后并发症、淀粉酶、脂肪酶以及诊断准确度来比较两者的诊断价值.结果 ERCP术后病人的并发症发病率明显高于行MRCP检查的病人(P＜0.01),ERCP检查后病人的淀粉酶和脂肪酶水平高于MRCP术后的病人(P＜0.05),两者诊断准确度经比较无差异(P＞0.05).结论 对低位梗阻性黄疸病人的诊断应首选MRCP,需作进一步确诊时再选用ERCP.     

An adult choledochal cyst—the magnetic resonance cholangiopancreatography findings: Report of a case

We herein report an unusual adult patient with a congenital choledochal cyst. A 28-year-old woman presented with recurrent episodes of abdominal pain in the right upper quadrant. Abdominal ultrasonography showed fusiform dilatation of the common bile duct without any obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) were performed to make a precise diagnosis. No abnormal pancreatobiliary junction was detected on ERCP. The MRCP images more clearly defined the type and extent of the choledochal cyst as observed at surgery. The cyst and gallbladder were excised and a Roux-en-Y hepaticojejunostomy was performed. We also reviewed the relevant English literature and concluded that MRCP offers diagnostic information that is equivalent or superior to that of ERCP for the evaluation of type I choledochal cysts in adults and because this modality is noninvasive, it should therefore be the preferred imaging technique for an examination of adult patients with choledochal cysts.     

Prospective validation study of an algorithm for triage to MRCP or ERCP for investigation of suspected pancreatico-biliary disease

Background In patients with suspected pancreatico-biliary disease, endoscopic retrograde cholangiopancreatography (ERCP) should be reserved for those requiring therapeutic intervention. However, difficulty arises in identifying patients likely to require therapy in the early phase of diagnostic work-up. An algorithm has been developed by the authors based upon prospective assessment of ERCP patients for triage of patients to magnetic resonance cholangiopancreatography (MRCP) or ERCP with suspected pancreatico-biliary disease. We aimed to validate this algorithm in an independent group of patients using a different group of endoscopists blinded to the algorithm. Methods Patients were stratified into different categories by clinical, ultrasound and liver function test findings. The algorithm stratified patients by the likelihood of therapeutic intervention. The accuracy of the algorithm for a therapeutic outcome was assessed by receiver operator characteristics (ROC) curve analysis. Results Hundred and twenty-five consecutive patients (Oct 2005 to July 2006) were prospectively assessed by MRCP or ERCP according to the algorithm, and the outcomes recorded. Fifty-seven patients were triaged to MRCP and 63 patients were triaged to ERCP. A category was not assessable in five patients. Three patients from the MRCP group required subsequent therapeutic ERCP. Diagnostic ERCP was performed in three patients in the ERCP group. ERCP-related complications occurred in four patients. The algorithm performed well in predicting the requirement for intervention as determined by the area under the ROC curve [0.84 (95%CI 0.76–0.92)]. Conclusions Our study confirms that an algorithm-based approach can reproducibly predict those patients requiring therapeutic biliary intervention.     

Magnetic resonance cholangiopancreatography: A novel approach to the evaluation of suspected pancreaticobiliary neoplasms

Background: Magnetic resonance cholangiopancreatography (MRCP) is a new noninvasive diagnostic method for pancreaticobiliary (PB) imaging without endoscopy, sedation, or iodinated contrast. The purpose of this study was to evaluate the ability of MRCP to depict pancreatic and biliary ductal anatomy compared to that of endoscopic retrograde cholangiopancreatography (ERCP) and to evaluate the ability of MRCP to accurately diagnose PB neoplasms. Methods: Twenty patients had MRCP, and 17 also had ERCP. All studies were read prospectively by experienced reviewers blinded to other imaging data. Pathologic diagnosis was made in all patients. Results: Bile duct dilatation seen by ERCP in 14 of 17 patients was correctly identified by MRCP in all 14 patients, and normal ducts were correctly identified by MRCP in the other 3 patients. The pancreatic duct was visible on MRCP in the pancreatic head in 17 of 20 patients, the body in 17 of 20 patients, and the tail in 15 of 20 patients. At ERCP, pancreatic duct dilatation was present in 11 cases and was identified by MRCP in 10 of them. Eighteen of 20 patients had malignant PB neoplasms. MRCP indicated PB neoplasm in 19 patients. Seventeen of these 19 patients had histologically confirmed malignant neoplasms pathologically, whereas 2 had benign pathology (both chronic pancreatitis). Among the 17 patients who also had ERCP, MRCP and ERCP correctly agreed on a final diagnosis of malignant neoplasm in 14 cases. In the three cases in which MRCP and ERCP disagreed on a final diagnosis, MRCP was correct in one and incorrect in two. Conclusions: MRCP can accurately and noninvasively delineate PB ductal anatomy and diagnose PB neoplasms comparably to ERCP. MRCP is an interesting new noninvasive method for evaluating patients with suspected PB neoplasms. Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

单次激发半傅立叶FSE序列MRCP的应用

目的评价单次激发半傅立叶FSE序列MRCP图像质量及诊断价值，分析胆道梗阻性疾病的MRCP影像学表现。方法218例病人行单次激发半傅立叶FSE序列MRCP扫描，然后对图像进行质量评价，根据ERCP及手术结果对照分析胆道梗阻性疾病的MRCP的影像学征象和特点，讨论单次激发半傅立叶FSE序列MRCP在胆道梗阻性疾病中的诊断价值。结果单次激发半傅立叶FSE序列MRCP扫描时间为5～7S，优良图像为82．5％，合格图像为10，6％，差为6．9％。单次激发半傅立叶FSE序列MRCP在胆道梗阻性疾病中，对各类梗阻疾病的定位诊断率为100％，梗阻端形态，胆胰管之间的关系均可显示。病因定性诊断率为95．5%。结论单次激发半傅立叶FSE序列MRCP不受呼吸运动影响，图像优质率高，扫描速度快，可显示各种疾病的胆胰管梗阻改变，对诊断较小的结石及泥沙样结石有较大的价值，诊断较早期胆管癌准确率高，可满足临床诊断的要求。     

磁共振胆胰管成像对肝胆胰疾病的诊断价值

本文通过分析１２例不同肝胆胰疾病患者的磁共振胰胆管成像（ＭＲＣＰ）并与手术结果相对照，探讨ＭＲＣＰ对肝胆胰疾病的诊断价值。在常规腹部ＭＲ扫描后，加重Ｔ２加权快速自旋回波序列，所得图像用计算机进行后处理，形成类似造影效果的重叠图像。在１２例患者中，ＭＲＣＰ清楚显示扩张的肝内、肝外胆管及梗阻部位的有１１例。作者还结合文献复习，总结了ＭＲＣＰ与ＥＲＣＰ各自的特点。     

磁共振胆道成像在ERCP不成功病人中的应用

目的：MRCP在ERCP不成功或显影不佳时的应用价值。方法：26例患者在ERCP不成功或显影不佳后48小时内行MRCP检查。结果：全部病例均获有诊断价值的图像,胆胰管正常4例,胆囊管过长伴结石1例,胆总管及肝内胆管结石11例,肝门部胆管癌5例,胰头癌1例,胆总管囊肿2例,肝门部胆管狭窄2例,MRCP对本组疾病总的诊断符合率为88％。结论：MRCP对胆胰疾病有较高的诊断价值。     

磁共振胆胰管成象的优越性和局限性

探讨磁共振胆胰管成象(MRCP)诊断胆胰疾病的优越性和局限性。方法:回顾性分析50例疑有胆胰疾病的MRCP图象,并在部分病例中将MRCP与ERCP和PTC的结果作对照。结果:50例全部获得有诊断价值的MRCP图象,成象率达100％。肝外胆管、肝管分叉部及胰管显示率分别为100％(50/50)、94％(47/50)和44％(22/50)。良性病变34例,MRCP诊断正确率97％(33/34),恶性病变13例的诊断正确率仍达92％(12/13)。结论:MRCP对胆胰疾病的诊断在多方面已可取代ERCP和PTC。但MRCP在判断胆道梗阻是否完全、肿瘤的定性诊断等方面尚存在一定的局限性。     

NMR cholangiography in the diagnostic algorithm of candidates to video laparocholecystectomy

BACKGROUND: High resolution magnetic resonance cholangiopancreatography (MRCP) is a non invasive imaging modality for depicting the pancreatobiliary tree. It can demonstrate dilation, stenosis and intraductal filling defects of both the biliary and the pancreatic duct. The imaging quality of high resolution MRCP is excellent. MRCP appears to be more effective and less invasive than endoscopic retrograde cholangiopancreatography (ERCP) to evaluate many pancreatic and biliary diseases as choledocholithiasis, malignant obstruction, incomplete or failed ERCP, postsurgical alterations of the biliary tract (as biliary-enteric anastomoses), sclerosing cholangitis, chronic pancreatitis, and congenital anomalies of the biliary and pancreatic duct. METHODS: MRCP was performed in 21 non selected patients with suspected choledocholithiasis and demonstrated the presence of stones in the biliary tract in 5 of them. In these 5 patients sequential endoscopic-laparoscopic treatment was performed and confirmed in all cases the presence of stones in the biliary tree. Laparoscopic cholecystectomy (VLC) and transcystic cholangiography was attempted in the restant 16 patients. RESULTS: Laparoscopic transcystic cholangiography confirmed in all cases the response of MRCP. CONCLUSIONS: MRCP has the potential to replace ERCP in the management of patients candidate to VLC with suspected choledocholithiasis.