磁共振胰胆管成像与内镜逆行胰胆管造影术对梗阻性黄疸的诊断价值

目的：评价磁共振胰胆管成像（MRCP）与经内镜胰胆管造影（ERCP）对梗阻性黄疸的诊断价值。方法：对32例梗阻性黄疸患者先后进行MRCP与ERCP检查，所有诊断均经手术或病理证实。结果：MRCP与ERCP对梗阻的定位准确率分别为90.6％（29/32）及82.8％（24/29），两者差异无统计学意义（P=0.5960），合并两者检查的准确率为96.9％（31/32），与单项MRCP(P=0.3010)、ERCP(P=0.0643)准确率差异无显著性意义。MRCP与ERCP对梗阻的定性诊断准确性分别为75.0％（24/32）及72.4（21/29），两者间差异无显著意义（P=0.9503），合并两者检查的准确率为93.8％（30/32），高于MRCP(P=0.0387)或ERCP(P=0.0245)单项检查。结论：MRCP与ERCP都是有效、安全的诊断梗阻性黄疸的方法，MRCP与ERCP相结合诊断准确率可进一步提高。     

超声内镜与磁共振胰胆管造影诊断梗阻性黄疸的效果比较

目的对比超声内镜(EUS)与磁共振胰胆管造影(MRCP)对梗阻性黄疸的诊断价值。方法收集2015年1月-2016年3月于首都医科大学附属北京天坛医院就诊的梗阻性黄疸患者31例,所有患者均行EUS、MRCP检查,比较EUS、MRCP诊断梗阻性黄疸的敏感度、特异度、准确度、Youden指数。结果 31例患者中胆总管结石16例(51.61%),壶腹肿瘤1例(3.23%),十二指肠乳头肿瘤6例(19.35%),胰头肿瘤3例(9.68%),胆管肿瘤2例(6.45%),胆管炎症2例(6.45%),1例(3.23%)经内镜逆行胰胆管造影、EUS、MRCP均未见结石、占位。对壶腹肿瘤、十二指肠乳头肿瘤、胰头肿瘤EUS诊断符合率均为100%;MRCP的胆总管结石诊断符合率、总诊断符合率均低于EUS(81.25%vs 93.75%,76.67%vs 90.00%)。EUS和MRCP诊断梗阻性黄疸的敏感度分别为90.00%和76.70%,特异度均为100%,准确度分别为90.30%和77.40%,Youden指数分别为0.90和0.77。结论对于梗阻性黄疸的诊断,EUS较MRCP拥有更高的诊断价值。     

胰腺癌的内镜逆行胰胆管造影诊断

应用内镜逆行胰胆管造影(ERCP)诊断胆胰管疾病已有30多年的历史，造影成功率可达85％～95％．已成为诊断胆胰管结石、胆管良恶性狭窄和畸形、胆囊和胆囊管病变等胆胰管疾病和鉴别诊断疑难性腹痛的重要手段之一。ERCP对梗阻性黄疸、十二指肠乳头肿瘤和胰管异常的鉴别诊断尤为有利,检查中收集的胆汁和胰液还可作细菌培养和细胞学检查。磁共振胰胆管造影(MRCP)为无创伤性检查，诊断较为准确，有可能取代诊断性ERCP，但并不能取代ERCP在治疗方面的作用。     

磁共振胰胆管造影、超声内镜与逆行胰胆管造影诊断阻塞性黄疸的价值

目的：比较磁共振胰胆管造影（MRCP）、超声内镜（EUS）与内镜逆行胰胆管造影（ERCP）诊断阻塞性黄疸的价值。方法：39例阻塞性黄疸患者分别行MRCP、EUS和ERCP。MRCP采用重T2加权及超快速自旋回波水成像技术进行,EUS和ERCP按常规进行。结果：MRCP、EUS与ERCP诊断准确率分别为87．2％（34／39例）、94．9％（37／39例）和97．4％（38／39例）;对恶性狭窄的诊断准确率分别为61．5％（8／13例）、84．6％（11／13例）和92．3％（12／13例）;对胆总管结石的诊断准确率均为100．0％（21／21例）。结论：MRCP为无创性检查,在明确阻塞性黄疸病因时可作为首选方法,目前尚不能取代ERCP。EUS作为诊断胆、胰系统疾病的重要方法,与MRCP和ERCP结合,能提高阻塞性黄疸诊断 的准确率。     

低场强磁共振胰胆管成像的临床应用价值

目的探讨低场强磁共振胰胆管成像(MRCP)在临床中的应用及效果评价。方法通过利用GE0.2T磁共振仪,对70例梗阻性黄疸患者进行MRCP检查,将其影像表现与临床及病理对照分析,以评价低场强MRCP检查的效果。结果70例梗阻性黄疸患者均能较好地显示胆管扩张,患者均经一次扫描成像,基本满足诊断要求。结论利用低场强磁共振进行MRCP检查,具有无创、安全、简单易行、可显示梗阻部位、准确判断引起梗阻原因等优点,基本可以达到高场强磁共振仪的扫描效果。     

磁共振胰胆管造影术与经内镜逆行胰胆管造影术诊断阻塞性黄疸的价值评价

目的:比较磁共振胰胆管造影术(MRCP)与经内镜逆行胰胆管造影术(ERCP)对阻塞性黄疸的诊断价值.方法:55例阻塞性黄疸患者分别行MRCP和ERCP,其中1例行ERCP失败者改行经皮肝胆管造影术(PTC).MRCP采用重T2加权及超快速自旋回波水成像技术进行,ERCP和PTC按常规方法进行.结果:MRCP与ERCP(或PTC)总的诊断准确率分别为90.9%(50/55)和98.2%(54/55),对恶性狭窄的诊断准确率为73.7%(14/19)和94.7%(18/19),对胆总管结石的诊断准确率均为100%(30/30).结论:MRCP为无创性检查,漏诊率较低但误诊率较高,在明确阻塞性黄疸病因时虽可作为首选方法,但不能取代ERCP(或PTC),两者结合使用可以弥补对方的不足,提高对阻塞性黄疸病因诊断的准确率.     

梗阻性黄疸的MRCP表现（附47例报告并文献复习）

目的 总结梗阻性黄疸的MRCP表现,提高其诊断的准确性.方法 回顾分析47例经手术和病理证实的梗阻性黄疸患者的MRCP表现.结果 恶性梗阻性黄疸25例,其中肝门胆管癌6例,胆囊癌2例,胆总管腺癌4例,胰头癌、十二指肠腺癌各3例,胰头转移瘤7例.良性梗阻性黄疸22例,其中炎性梗阻3例,胆囊或胆总管结石伴炎症13例,术后瘢痕、胆总管囊肿、十二指肠息肉各2例.恶性梗阻性黄疸的典型MRCP表现为肝内胆管呈"藤蔓"征,胆管突然截断,断端圆钝形态不规则,呈偏心性或向心性狭窄或充盈缺损.良性梗阻性黄疸的MRCP表现为肝内胆管呈"枯树枝"征,胆总管逐渐变窄或其内形态规则的充盈缺损,断端锐利、平直或倒杯口状或圆锥状.结论 MRCP是诊断良、恶性梗阻性黄疸的有效方法.     

逆行胰胆管造影在胰胆疾病诊疗中的现状

内镜逆行胰胆管造影(ERCP)能通过十二指肠镜直接观察壶腹乳头区病变,并通过乳头插管造影显示胰管、胆管和胆囊,可以区别肝内或肝外阻塞以及阻塞部位和形态,并     

经内镜逆行胰胆管造影和十二指肠乳头切开术50例的护理体会

目的 探讨内镜下逆行胰胆管造影术(ERCP)及十二指肠乳头切开取石术(EST)的护理措施.方法 对50例采用十二指肠镜在数字减影血管造影(DSA)下行十二指肠乳头插入导管进行胰胆管造影及十二指肠乳头切开治疗的患者的护理配合体会进行总结分析.结果 50例患者ERCP检查确诊为胆总管结石20例、原发性硬化性胆管炎3例、胆管肿瘤8例、急性胰腺炎6例、胰头癌10例、慢性胰腺炎3例,通过治疗及护理均未发生感染、胰腺炎、出血及穿孔情况.结论 ERCP术是微创肝、胆、胰系统疾病的重要诊治方法,加强手术前后的护理是手术成功的关键.     

磁共振胰胆管造影与经内镜胰胆管造影在老年胆道梗阻病变中的诊断价值

<正>正确判断胆道梗阻原因对于制订治疗方案,评估预后具有重要意义〔1〕。磁共振胰胆管造影(MRCP)是一种无创性胰胆管成像技术,利用MR重T2加权效果显示含液体的胰管和胆管,提供完整的胰胆管影像,对于诊断胆道系统疾病具有重要价值〔2,3〕。经内镜胰胆管造影(ERCP)是检查胆道梗阻性疾病的金标准,但是作为一种有创性检查,容易导致多种并发症。本研究对比MRCP与ERCP对胆道梗阻病变的诊断价值。     

ERCP在不明原因肝外阻塞性黄疸的临床应用

目的探讨内镜逆行胰胆管造影（ERCP）在经常规检查不明原因肝外阻塞性黄疸的临床应用价值。方法收集经B超、cT和,或MRCP检查诊断不明原因胆胰疾病或肝外胆管梗阻病人45例,男28例,女17例,年龄21—80岁,均行ERCP术。结果45例病人行ERCP术,其中42例诊断为胆道微结石（Biliary microlithiasis,BML）,42例均行乳头扩张术／EST4-胆道取石术;3例为胆总管下端炎性狭窄而行胆道内支架植入术;1例ERCP取石术后并发轻症胰腺炎,经内科保守治疗后痊愈,l例因腹痛再发行胆囊切除术,其余患者经ERCP治疗后腹痛、黄疸均缓解。结论BML是不明原因肝外阻塞性黄疸的主要原因,ERCP是不明原因肝外阻塞性黄疸安全、有效的诊断及治疗手段。     

磁共振胆胰管造影联用动态增强对胆管癌的诊断价值

目的：评价屏气磁共振胆胰管造影(MRCP)及联合应用动态增强MRI对胆管癌的临床诊断价值。方法：回顾性分析88例经手术、病理证实的胆管癌的MRCP及动态增强MRI表现。结果：88例检查均一次成功，全部病例胆胰管显示满意。MRCP对肝门型胆管癌和肝外胆管型胆管癌的定位诊断准确率均为l00％，定性诊断准确率为100％和52．2％，结合动态增强MRI扫描，对肝外胆管型胆管癌定性诊断准确率提高到91．3％。结论：MRCP检查成功率高，对肝门型胆管癌和肝外胆管型胆管癌定位准确，结合动态增强MRI扫描，定性诊断也有较高准确性。     

低位梗阻性黄疸的影像与内镜诊断价值探讨

目的探讨影像与内镜检查在低位梗阻性黄疸中的诊断价值及科学组合与合理应用。方法回顾分析57例低位梗阻性黄疸患者的病因及体表超声（US）、cT、MRI＋MRCP、ERCP和EUS等诊断结果,总结各检查方法在低位梗阻性黄疸诊断中的适应证和诊断价值。结果57例低位梗阻性黄疸患者中,良性梗阻42例,其中胆总管结石38例,胆总管蛔虫1例,胆道术后良性狭窄2例,胰头部慢性胰腺炎1例;恶性梗阻15例,其中胰头癌11例,壶腹癌4例。US、CT、MRI＋MRCP、ERCP、EUS对低位梗阻性黄疸的定位诊断准确率分别为71．93％（41／57）、88．00％（22／25）、94．59％（35／37）、100．00％（47／47）、96．77％（30／31）;定性诊断准确率分别为63．16％（36／57）、80．00％（20／25）、83．78％（31／37）、100．00％（47／47）、96．77％（30／31）。结论良性病变是低位梗阻性黄疸的主要原因,但恶性病变并不少见,影像或内镜检查对于明确诊断至关重要,策略性、程序性选择应用各种检查方法,尤为必要。     

Endoscopic ultrasound-guided choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography

Endoscopic ultrasonography （EUS）-guided biliary drainage was performed for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography （ERCP）. In the present study, we introduced the feasibility and outcome of EUS-guided choledochoduodenostomy in four patients who failed in ERCR We performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of cancer of the head of pancreas. Using a curved linear array echoendoscope, a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. Using a biliary catheter for dilation, or papillary balloon dilator, a 7-Fr plastic stent was inserted through the choledochoduodenostomy site into the extrahepatic bile duct. In 3 （75%） of 4 cases, an indwelling plastic stent was placed, and in one case in which the stent could not be advanced into the bile duct, a naso-biliary drainage tube was placed instead. In all cases, the obstructive jaundice rapidly improved after the procedure. Focal peritonitis and bleeding not requiring blood transfusion was seen in one case. In this case, pancreatoduodenectomy was performed and the surgical findings revealed severe adhesion around the choledochoduodenostomy site. Although further studies and development of devices are mandatory, EUS-guided choledochoduodenostomy appears to be an effective alternative to ERCP in selected cases.     

Diagnostic role of secretin-enhanced MRCP in patients with unsuccessful ERCP

AIM: To evaluate the value of MR cholangiopancreatography (MRCP) in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessfully performed by experts in a tertiary center. METHODS: From January 2000 to June 2003, 22 patients fulfilled the inclusion criteria. The indications for ERCP were obstructive jaundice (n = 9), abnormal liver enzymes (n = 8), suspected chronic pancreatitis (n = 2), recurrent acute pancreatitis (n = 2), or suspected pancreatic cancer (n = 1). The reasons for the ERCP failure were the postsurgical anatomy (n = 7), duodenal stenosis (n = 3), duodenal diverticulum (n = 2), and technical failure (n = 10). MRCP images were evaluated before and 5 and 10 min after i.v. administration of 0.5 IU/kg secretin. RESULTS: The MRCP images were diagnosed in all 21 patients. Five patients gave normal MR findings and required no further intervention. MRCP revealed abnormalities (primary sclerosing cholangitis, chronic pancreatitis, cholangitis, cholecystolithiasis or common bile duct dilation) in 10 patients, who were followed up clinically. Four patients subsequently underwent laparotomy (hepaticojejunostomy in consequence of common bile duct stenosis caused by unresectable pancreatic cancer; hepaticotomy+Kehr drainage because of insufficient biliary-enteric anastomosis; choledochojejunostomy, gastrojejunostomy and cysto-Wirsungo gastrostomy because of chronic pancreatitis, or choledochojejunostomy because of common bile duct stenosis caused by chronic pancreatitis). Three patients participated in therapeutic percutaneous transhepatic drainage. The indications were choledocholithiasis with choledochojejunostomy, insufficient biliary-enteric anastomosis, or cholangiocarcinoma. CONCLUSION: MRCP can assist the diagnosis and management of patients in whom ERCP is not possible.     

超声内镜诊断肝外型恶性阻塞性黄疸

对５５例肝外型恶性阻塞性黄疸于手术前进行了内镜超声检查。乳头癌２２例中，诊断正确率为９５％，病变大小判断正确率为８５％；对胰头癌及胆总管末端癌的确诊率也均高于体外“Ｂ”超检查；对乳头癌浸润十二指肠壁深度的判断与病理诊断的符合率为７０％；癌周肿大淋巴结的发现率为７５％。     

Hepatocellular carcinoma with obstructive jaundice： diagnosis,treatment and prognosis

Obstructive jaundice as the main clinical feature is uncommon in patients with hepatocellular carcinoma (HCC). Only 1-12 % of HCC patients manifest obstructive jaundice as the initial complaint. Such cases are clinically classified as “icteric type hepatoma”, or “cholestatic type of HCC”. Identification of this group of patients is important, because surgical treatment may be beneficial. HCC may involve the biliary tract in several different ways: tumor thrombosis, hemobilia,tumor compression, and diffuse tumor infiltration. Bile duct thrombosis (BDT) is one of the main causes for obstructive jaundice, and the previously reported incidence is 1.2-9 %.BDT might be benign, malignant, or a combination of both.Benign thrombi could be blood clots, pus, or sludge.Malignant thrombi could be primary intrabiliary malignant tumors, HCC with invasion to bile ducts, or metastatic cancer with bile duct invasion. The common clinical features of this type of HCC include: high level of serum AFP, history of cholangitis with dilation of intrahepatic bile duct; aggravating jaundice and rapidly developing into liver dysfunction. It is usually difficult to make diagnosis before operation, because of the low incidence rate, ignorant of this disease, and the difficulty for the imaging diagnosis to find the BDT preoperatively. Despite recent remarkable improvements in the imaging tools for diagnosis of HCC, such cases are still incorrecty diagnosed as cholangiocarcinoma or choledocholithiases. Ultrasonography (US) and CT are help fulin showing hepatic tumors and dilated intrahepatic and/or extrahepatic ducts containing dense material correspondingto tumor diebris. Direct cholangiography including percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP)remains the standard procedure to delineate the presence and level of biliary obstruction. Magnetic resonance cholangiopancreatography (MRCP) is superior to ERCP in interpreting the cause and depicting the anatomical extent of the perihilar obstructive jaundice, and is particularly distinctive in cases associated with tight biliary stenosis and along segmental biliary stricture. Choledochoscopy and bile duct brushing cytology could be alternative useful techniques in the differentiating obstructions due to intraluminal mass,infiltrating ductal lesions or extrinsic mass compression applicable before and after duct exploration. Jaundice is not necessarily a contraindication for surgery. Most patients will have satisfactory palliation and occasional cure if appropriate procedures are selected and carried out safely, which can result in long-term resolution of symptoms and occasional long-term survival. However, the prognosis of icteric type HCC is generally dismal, but is better than those HCC patients who have jaundice caused by hepatic insufficiency.     

Nonoperative imaging techniques in suspected biliary tract obstruction

Evaluation of suspected biliary tract obstruction is a common clinical problem. Clinical data such as history, physical examination, and laboratory tests can accurately identify up to 90% of patients whose jaundice is caused by extrahepatic obstruction. However, complete assessment of extrahepatic obstruction often requires the use of various imaging modalities to confirm the presence, level, and cause of obstruction, and to aid in treatment plan. In the present summary, the literature on competing technologies including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiopancreatography (PTC), endoscopic ultrasound (EUS), intraductal ultrasonography (IDUS), magnetic resonance cholangiopancreatography (MRCP), helical CT (hCT) and helical CT cholangiography (hCTC) with regards to diagnostic performance characteristics, technical success, safety, and cost-effectiveness is reviewed. Patients with obstructive jaundice secondary to choledocholithiasis or pancreaticobiliary malignancies are the primary focus of this review. Algorithms for the management of suspected obstructive jaundice are put forward based on current evidence. Published data suggest an increasing role for EUS and other noninvasive imaging techniques such as MRCP, and hCT following an initial transabdominal ultrasound in the assessment of patients with suspected biliary obstruction to select candidates for surgery or therapeutic ERCP. The management of patients with a suspected pancreaticobiliary condition ultimately is dependent on local expertise, availability, cost, and the multidisciplinary collaboration between radiologists, surgeons, and gastroenterologists.     

Idiopathic fibrosing pancreatitis associated with ulcerative colitis

Idiopathic fibrosing pancreatitis has been associated with Sjögren''s syndrome, primary biliary cirrhosis and primary sclerosing cholangitis. This condition frequently develops in childhood and youth, and has also been related to ulcerative colitis and pericholangitis. Pancreatic complications have been rarely described as systemic complications of ulcerative colitis. A 25-year-old man presented with epigastric pain and jaundice. Abdominal ultrasonography, computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) revealed a diffuse enlargement of the pancreas, filiform distal stenosis of the common bile duct and intrahepatic bile ducts, and pancreatic duct dilatation. At operation, a rock-hard and nodular pancreas was noted. Cholecystectomy and Roux-en-Y hepaticojejunostomy, with an access loop, was successfully performed. Idiopathic fibrosing pancreatitis should be considered in young patients with obstructive jaundice, especially those affected with chronic inflammatory or autoimmune diseases. Glucocorticoid therapy would be the first-line treatment, although many patients require operation.