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？…

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列阻塞性黄疸患者分别行ＭＲＣＰ和ＥＲＣＰ,其中１例行ＥＲＣＰ失败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）,     

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.     

逆行胰胆管造影对梗阻性黄疸的诊断价值

ＥＲＣＰ对梗阻性黄疸的诊断价值。３２例梗阻性黄疸做逆行胰胆管造影（ＥＲＣＰ），与Ｂ超和ＣＴ进行对比，探讨对其定位与病因的诊断价值。结果：恶性胆道梗阻１８例（５６．３％），良性梗阻１４例（４３．７％）。ＥＲＣＰ、Ｂ超及ＣＴ定位诊断率分别为９３．７％、８７．５％与８１．３％，三者比较差异无显著性（Ｐ＞０．０５）；病因诊断率分别为９０．６％、６２．５％与５６．３％，ＥＲＣＰ与Ｂ超和ＣＴ比较差异显著（Ｐ＜０．０５）；误诊率分别为９．４％、９．４％与３．１％，三者比较无显著性差异（Ｐ＞０．０５）。ＥＲＣＰ对梗阻性黄疸的病因诊断率明显优于Ｂ超和ＣＴ，对梗阻性黄疸是一种安全且不可缺少的诊断方法。     

逆行胰胆管造影对梗阻性黄疸的诊断价值

ＥＲＣＰ对梗阻性黄疸的诊断价值。３２例梗阻性黄疸做逆行胰胆管造影（ＥＲＣＰ），与Ｂ超和ＣＴ进行对比，探讨对其定位与病因的诊断价值。结果：恶性胆道梗阻１８例（５６．３％），良性梗阻１４例（４３．７％）。ＥＲＣＰ、Ｂ超及ＣＴ定位诊断率分别为９３．７％、８７．５％与８１．３％，三者比较差异无显著性（Ｐ＞０．０５）；病因诊断率分别为９０．６％、６２．５％与５６．３％，ＥＲＣＰ与Ｂ超和ＣＴ比较差异显著（Ｐ＜０．０５）；误诊率分别为９．４％、９．４％与３．１％，三者比较无显著性差异（Ｐ＞０．０５）。ＥＲＣＰ对梗阻性黄疸的病因诊断率明显优于Ｂ超和ＣＴ，对梗阻性黄疸是一种安全且不可缺少的诊断方法。     

逆行胰胆管造影对梗阻性黄疸病因的诊断价值

随着消化内镜性能的不断改进和插管技术的提高，ERCP已成为诊断胆胰疾病的重要方法。本对梗阻性黄疸行ERCP检查，并与B超、CT对比，探讨ERCP对梗阻性黄疸病因的诊断价值。     

磁共振胰胆管水成像与内镜下逆行胰胆管造影术临床应用的对比研究

目的通过磁共振胰胆管水成像（MRCP）与内镜下逆行胰胆管造影术（ERCP）对胆胰疾病诊断的对比研究,为临床更好地选择诊治方案提供依据。方法回顾性分析120例行ERCP和（或）MRCP检查并经手术、病理等证实为胆胰疾病患者的临床资料。结果 MRCP和ERCP对胆道结石和胆管癌诊断的总符合率比较,无统计学差异（P均〉0.05）,对壶腹癌、慢性胰腺炎、胆囊切除术后胆汁漏或梗黄诊断符合率比较,差异均有统计学意义（P〈0.05）。ERCP有较好的治疗作用。结论 MRCP与ERCP各有优势,可以互相补充,根据胆胰疾病患者的临床表现、检查目的及治疗手段对两者的合理选择至关重要。     

磁共振胰胆管造影术与内镜逆行胰胆管造影术的对照研究

目的 通过磁共振胰胆管造影术（ＭＲＣＰ）与内镜逆行胰胆管造影术（ＥＲＣＰ）的对照研究,评价ＭＲＣＰ对胰胆系疾病的诊断价值。方法 ４０例疑有胰胆系疾病的患者进行了ＭＲＣＰ及ＥＲＣＰ检查,两者结果作对照研究。结果 本组资料中ＭＲＣＰ对胰胆系疾病总的诊断价值为敏感度８９．１％、特异度１００％、准确度９０％,ＥＲＣＰ总的诊断价值为敏感度８４．２％、特异度１００％、准确度８５％,两者统计学上无显著性差异。结     

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。     

B超联合磁共振胰胆管成像对梗阻性黄疸的诊断价值

目的探讨B超与磁共振胰胆管成像检查在梗阻性黄疸诊断中的价值。方法对66例梗阻性黄疸患者进行超声和MRCP检查,并给予手术治疗。结果 B超联合MRCP诊断梗阻性黄疸的正确率为92.4%,其中对13例胰头癌的诊断正确率为100%,13例壶腹部癌的诊断正确率为84.6%,19例胆管癌的诊断正确率为84.2%;对15例胆管结石的诊断正确率为100%,6例良性胆道狭窄为100%。结论 B超联合MRCP检查对诊断梗阻性黄疸有很高的临床应用价值。     

经内镜逆行胰胆管造影与超声、多排螺旋CT、磁共振胰胆管造影对梗阻性黄疸诊断价值的比较

目的比较内镜下逆行胰胆管造影(ERCP)与超声、多排螺旋CT(MSCT)及磁共振胰胆管造影(MRCP)对梗阻性黄疸的部位及病因诊断的准确率。方法 128例患者行超声、MSCT及ERCP检查,其中35例患者行MRCP检查。结果在梗阻部位的诊断上,四种方法对肝内胆管和胰头部的诊断准确率差异无统计学意义;ERCP对肝外胆管梗阻的诊断准确率与MRCP差异无统计学意义,但显著高于超声和MSCT;在病因诊断上,对于胆系结石、胆管炎和胰头癌的诊断准确率,四种方法差异无统计学意义;MRCP、ERCP和MSCT对于胆管癌诊断准确率均优于超声;此外,ERCP在诊断乳头部肿瘤、十二指肠乳头旁憩室时优于超声和MSCT。结论 ERCP对梗阻性黄疸的部位(尤其是肝外胆管和十二指肠乳头部)及病因(胆管癌、十二指肠乳头部肿瘤)的诊断具有重要价值。     

Prospective evaluation of magnetic resonance cholangiopancreatography in patients with biliary disease: comparative study with conventional ultrasonography and endoscopic retrograde cholangiopancreatography: Diagnostic algorithm

BACKGROUND: Magnetic resonance cholangiopancreatography is an accurate technique that can replace invasive diagnostic methods of the biliary and pancreatic duct. AIMS: Our aim was to assess sensitivity and specificity of magnetic resonance cholangiopancreatography and ultrasonography using the results of endoscopic retrograde cholangiopancreatography as reference, and to establish a diagnostic algorithm under which circumstances magnetic resonance cholangiopancreatography can replace endoscopic retrograde cholangiopancreatography. PATIENTS: Eighty-three patients with suspicion of biliary disease based on clinical, biochemical and ultrasonography findings were studied. METHODS: Ultrasonography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were performed, comparing the results of the techniques for the determination of their sensitivity and specificity. RESULTS: Sensitivity and specificity results obtained by magnetic resonance cholangiopancreatography were: 100 and 92.8% when dilated ducts were detected (n=61); 97.4 and 97.2% in the diagnosis of choledocholithiasis (n=38); 100 and 96.7% in malignant lesions (n=14) and 81.8 and 98.4% when biliary ducts were normal. The percentage of images of diagnostic quality was 97.6%. Sensitivity and specificity achieved by ultrasonography was: 100 and 57.1% in detection of dilatation, 71 and 97.2% in choledocholithiasis, 92.8 and 96.7% in malignancy and 66.6 and 96.8% in normal ducts. CONCLUSIONS: Magnetic resonance cholangiopancreatography is a technique with high sensitivity and specificity in the evaluation of biliary ducts. Thus, magnetic resonance cholangiopancreatography may replace diagnostic endoscopic retrograde cholangiopancreatography for purely diagnostic purposes, following an initial clinical and ultrasonographic exam.     

Prospective study of diagnostic value of magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography in cholangiopancreatic diseases

OBJECTIVE: To compare the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) versus endoscopic retrograde cholangiopancreato­graphy (ERCP) in the detection of cholangiopan­creatic diseases via a prospective study. METHODS: Magnetic resonance cholangiopancreatography was performed in 63 patients with suspected cholangiopancreatic diseases and followed by ERCP within 24 h. The MRCP and ERCP images were analyzed and compared. RESULTS: Of the 63 patients studied, 56 (88.9%) were correctly diagnosed by using ERCP and seven (11.1%) by using percutaneous transhepatic cholangio­graphy (PTC); however, all these patients were successfully diagnosed by using MRCP. Cholangio­pancreatic diseases were diagnosed by MRCP with a sensitivity of 98.2%, a specificity of 83.3%, a misdiagnostic rate of 16.7% and a missed diagnostic rate of 1.8%. The total concordance rate of MRCP, ERCP and PTC was 85.7%. For specific conditions, the concordance rates were as follows: biliary calculi 100%; tumors of the bile duct 92.9%; papillary lesions 70.6%; hepatic distomiasis 66.7%; chronic pancreatitis 100%. The complications associated with ERCP were five cases of acute pancreatitis and one case of perinephric abscess. The patient with perinephric abscess had previously had a B‐II operation. The complication rate associated with ERCP was 9.5% (6/63), but no complications were associated with MRCP. CONCLUSION: We conclude that MRCP is as effective as ERCP for the diagnosis of bile duct lesions, such as biliary calculi and tumors, but not for papillary lesions and liver fluke infections. Although MRCP can be used in patients who can’t tolerate ERCP or when there are contraindications to using ERCP, it should not be used for therapeutic purposes.     

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。     

ERCP结合EPT对胆囊切除术后患者诊治价值的探讨

目的 回顾性研究逆行性胰胆管造影（ERCP）结合乳头肌切开术（EPT）对胆囊切除术后患者的诊治价值。方法 170例胆囊切除术后症状再发或反复发作患者,接受ERCP检查和EPT等治疗,诊断结果与B超作对照。同时动态观察内镜下介入诊治术后临床表现的改变。不良反应及血清淀粉酶的变化及高淀粉酶血症的分布情况。结果 经ERCP结合EPT等术后患者临床症状显著改善;与B超对照ERCP对胆囊切除术后胆总管残余结石的诊断率显著提高（P＜0．001）,对胆总管扩张程度的诊断价值显著优于B超（P＜0．05）,并能发现许多B超检查不能发现的胆胰病变;术后主要不良反应表现为出血、高淀粉酶血症,ERCP结合EPT等治疗组高淀粉酶的发生率显著高于单纯ERCP操作组（P＜0．01）。经积极地处理后短期内出血控制,血清淀粉酶多在3日内转为正常。结论 对胆囊切除术后患者,ECRP结合EPT不失为一项非常有价值、安全的诊治措施。     

Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types of reconstruction,cannulating a papilla with a reverse orientation,and performing therapeutic interventions with uncommon endoscopic accessories.The development of endoscopic techniques has led to higher success rates in this group of patients.Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction;however,these success rate is lower in long-limb reconstruction.ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length;however,it must be performed by a highly experienced and skilled endoscopist.Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography,but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy.Laparoscopic-assisted ERCP has an almost 100%success rate in longlimb reconstruction because of the use of a conventional side-view duodenoscope,which is compatible with standard accessories.This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy.This review focuses on the advantages,disadvantages,and outcomes of various procedures that are suitable in different situations and reconstruction types.Emerging new techniques and their outcomes are also discussed.     

治疗性ERCP在85岁以上高龄患者中的应用价值评价

目的 评价治疗性ERCP在85岁以上高龄老年人的安全性和有效性.方法 回顾性分析2004年至2009年间85岁以上ERCP患者（A组,52例）的临床资料,并与同期70～84岁ERCP患者（B组,329例）做比较.结果 A组患者伴发症（52/52）明显高于B组（255/329）,P〈0.05;对于胆总管结石者,需要多次取清结石者A组（19/52）明显多于B组（65/329）,P〈0.05;并发症发生率分别为（4/52）和（16/329）,P〉0.05;术后死亡率分别为（1/52）和（2/329）,P〉0.05.结论 治疗性ERCP对于85岁以上高龄老年人是安全有效的,但需严格掌握手术适应证.     

内镜逆行胰胆管造影对Mirizzi综合征的诊断价值

目的 探讨内镜逆行胰胆管造影（ＥＲＣＰ）对Ｍｉｒｉｚｚｉ综合征的诊断价值,提高对该病的术前诊断率。方法 对３０例Ｍｉｒｉｚｚｉ综合征的临床特征,实验室检查、十二指肠镜下特点及ＥＲＣＰ的Ｘ线表现进行分析,并与Ｂ超、ＣＴ检查棹比较。结果 Ｍｉｒｉｚｚｉ综合征病史较长,ＥＲＣＰ的典型表现为肝总管可风级完整的充盈缺损,缺损以上的肝总管及肝内胆管轻至重度扩张。并胆囊萎缩及胆囊结石。ＥＲＣＰ确诊率为８６．６７     

Diagnosis of mild chronic pancreatitis （Cambridge classification）： Comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography

AIM： To investigate the usefulness of secretin injection- MRCP for the diagnosis of mild chronic pancreatitis.
METHODS： Sixteen patients having mild chronic pancreatitis according to the Cambridge classification and 12 control subjects with no abnormal findings on the pancreatogram were examined for the diagnostic accuracy of secretin injection-MRCP regarding abnormal branch pancreatic ducts associated with mild chronic pancreatitis （Cambridge Classification）, using endoscopic retrograde cholangiopancreatography （ERCP） for comparison.
RESULTS： The sensitivity and specificity for abnormal branch pancreatic ducts determined by two reviewers were respectively 55%-63% and 75%-83% in the head, 57%-64% and 82%-83% in the body, and 44%-44% and 72%-76% in the tail of the pancreas. The sensitivity and specificity for mild chronic pancreatitis were 56%-63% and 92%-92%, respectively. Interobserver agreement （K statistics） concerning the diagnosis of an abnormal branch pancreatic duct and of mild chronic pancreatitis was good to excellent.
CONCLUSION： Secretin injection-MRCP might be useful for the diagnosis of mild chronic pancreatitis.