ERCP和MRCP在壶腹区梗阻性病变病因诊断中的对照研究

目的:分析MRCP在壶腹区梗阻性病变中的诊断价值及局限性。方法:搜集经手术和(或)ERCP病理证实的134例壶腹区梗阻性病变的MRCP和ERCP影像资料,并将其分为结石炎症组、恶性肿瘤组和乳头旁憩室组,进行对比分析。结果:134例壶腹区梗阻性病变共发现165个病因,MRCP和ERCP两种检查方法总的诊断准确率分别为79.4%和95.2%。胆总管下端结石和炎症112例,诊断准确率分别为96.4%和98.2%;壶腹区恶性肿瘤共31例,诊断准确率分别为58.1%和80.6%;十二指肠乳头旁憩室和憩室内乳头22例,诊断准确率分别22.7%和100%。结论:MRCP是无创性检查,可作为壶腹区梗阻性疾病的首选检查方法,ERCP可直视壶腹区情况并同时进行内镜下治疗或活检,两者结合互补,可提高壶腹区梗阻性疾病的诊断准确率。

ERCP compared with MRCP to analysis the diagnostic value and limitations of ampullary obstruction disease

Objective：To evaluate the diagnostic value and limitations of ampullary obstruction disease with MRCP.Methods：Collected the MRCP and ERCP data in 134 cases of ampullary obstruction diseases, which were confirmed by operation and（or） ERCP pathology,and divided into calculus inflammation group,malignant tumor group and peripapillary diverticulum group,and comparative analyzed.Results：134 cases of ampullary obstruction diseases find 165 causes.The two kinds methods of MRCP and ERCP showed total diagnostic accuracy rate of 79.4% and 95.2%.Calculus and inflammation in the distal common bile duct in 112 cases,diagnostic accuracy rates were 96.4% and 98.2%;ampullary malignant tumor in 31 cases,diagnostic accuracy rates were 58.1% and 80.6%;peripapillary duodenal diverticulum and papilla in diverticula in 22 cases,diagnostic accuracy rates were 22.7% and 100%.Conclusion：MRCP is a noninvasive examination,can be the first choice as a diagnosis method for ampullary obstruction disease,ERCP can look directly at the ampulla region and treatment or biopsy with using endoscopy at the same time.Combination of the two methods can promote the diagnostic accuracy rate for ampulla obstruction disease.