胰胆管疾病的ERCP影像诊断

目的评价内窥镜逆行胰胆管造影(ERCP)对胰胆管疾病的诊断价值。方法回顾性分析了经手术或病理及临床证实胰胆管疾病480例的ERCP表现,并与CT,MRI,MRCP,超声及透皮肝穿刺胆道造影(PTC)等检查方法进行对比。结果正常胰胆管75例,先天性胆管囊肿14例,胆系结石292例,奥狄括约肌狭窄症46例,壶腹癌、胆管癌52例,胰管癌4例,胰腺炎2例,胰管结石3例,胆道蛔虫症9例,肝内胆管发育变异2例,胆囊管异位开口6例,胆道-腹腔漏2例,十二指肠乳头旁憩室9例,十二指肠乳头开口于憩室内2例,肝移植后吻合口狭窄2例,肝移植后吻合口狭窄并胆漏1例,肝移植后肝外胆管条状结石2例。结论ERCP及MRCP检查同为诊断胰胆管疾病的“金标准”,但每种影像学方法均有其优缺点,应根据患者情况选择。ERCP虽有一定的创伤性,但检查同时可行内镜下乳头括约肌切开术(EST)等微创治疗。

Imaging diagnosis of cholangiopancreatic duct diseases with ERCP

Objective To assess the value of endoscopic retrograde cholangiopancreatography(ERCP)in the diagnosis of cholang-iopancreatic duct diseases(CPDD).Methods ERCP findings of 480 patients with surgically and pathologically or clinically proved CPDD were retrospectively analyzed and compared with CT,MRI,MRCP,Ultrasonography and percutaneous transhepatic cholangiography(PTC).Results Normal cholangiopancreatic ducts were found in 75 cases,congenital biliary cyst in 14,cholelithiasis in 292,Oddi' s sphincter stenosis in 46,ampullar-bile duct carcinoma in 52,pancreatic duct carcinoma in 4,pancreatitis in 2,pancreatic duet calculus in 3,biliary ascariasis in 9,intrahepatic bile duct displasia in 2,cystic duct ectopic aperture in 6,biliary tract-abdominal cavity leakage in 2,paraduodenal papilla diverticulum in 9,duodenal papilla opening into diverticulum in 2,anastomotic stenosis after hepatic transplantation in 2,anastomotic stenosis associated with biliary leakage in 1,and extrahepatic bile duct stripe calculus after hepatic transplantation in 2.Conclusion ERCP and MRCP are gold standard for diagnosis CPDD but they have independent advantage and defect so that their choice should be depend on patients' s state.Although ERCP is referred to invasive examination,it can simultaneously perform the microtraumatic treatment of endoscopic papillary sphincterotomy(EST).