磁共振胆胰管成像在腹腔镜手术治疗胆道结石中的应用价值

目的:探讨磁共振胆胰管成像(magnetic resonanced cholangio-pancreatography,MRCP)在腹腔镜手术治疗胆道结石中的应用价值。方法:连续为251例经B超诊断为胆道结石、最终行腹腔镜手术的患者术前行MRCP,以了解胆道结石、胆道变异情况,并与手术结果、术后病理进行对照分析。结果:MRCP诊断单纯性胆囊结石212例,胆囊结石合并肝内胆管结石2例,胆囊结石合并胆总管结石23例,单纯胆总管结石10例,胆囊癌、胰头癌各1例,其中胆道变异15例;以上病例均与手术结果、术后病理相符;2例仅提示胆总管扩张,未提示具体病因,经手术证实为化脓性胆管炎伴结石。MRCP对胆道结石、胆总管结石、胆道变异的诊断准确率分别为99%(247/249)、94%(33/35)、100%(15/15)。结论:MRCP对胆道结石及胆道变异具有较高的诊断准确率,腹腔镜胆道手术前常规行MRCP具有较高的临床价值。

The clinical value of magnetic resonance imaging in laparoscopic treatment of biliary calculi

Objective：To investigate the clinical value of magnetic resonance imaging（MRCP） in laparoscopic treatment of biliary calculi.Methods：Preoperative MRCP were conducted in 251 patients who were already diagnosed as cholelithiasis by ultrasonography previously to verify the existence biliary calculi and bile duct variations.Then the preoperative MRCP explorations were compared with the intraoperative findings and postoperative pathologic results.Results：Simple cholecystolithiasis was diagnosised in 212 cases by means of MRCP,gallbladder stone with hepatolithiasis in 2 cases,gallbladder with common bile duct calculus in 23 cases,pure common bile duct calculus in 10 cases,carcinoma of gallbladder and carcinoma of head of pancreas in each 1 cases,and biliary variation in 15 cases.The diagnosis of all cases by MRCP was in accord with intraoperative findings and postoperative pathologic results,2 cases manifesting incentive choledochectasia by MRCP were proved as suppurative cholangitis with stone by operations.The diagnostic accuracy of MRCP for biliary duct calculus,common bile duct calculus and biliary variations were 99%（247/249）,94%（33/35） and 100% respectively.Conclusions：MRCP has highly diagnostic accuracy for biliary calculus diseases and biliary variations,a routine MRCP scan before surgery is of great clinical value in management of biliary disease.