胰管结石影像特点及临床处理策略

目的 探讨胰管结石影像学特点及选择治疗策略。方法 对43例胰管结石的影像学特点进行回顾性分析，总结结石分布部位、大小、胰管形态学特点、诊断方法和内科保守治疗方法、ERCP取石以及外科手术治疗方法的选择。结果 43例胰管结石经影像学诊断42例，1例术中探查发现；其中B超确诊20例，CT10例，ERCP12例。结石位于胰头部10例，胰体、尾部29例，广泛分布4例。对20例位于胰体、尾部的单发胰管结石患者行内科保守治疗；6例结石位于胰头部者行ERCP乳头切开取石；17例患者胰管结石为多发，且广泛分布，大小在0．8～2．5cm，并伴有胰管形态学改变，经手术治疗痊愈。结论B超、CT或ERCP是确诊胰管结石较理想的方法，根据结石的特点选择治疗方案和手术术式在胰管结石治疗中具有重要意义。

Imaging characteristics and clinical management of pancreatic duct stones

Objective To investigate the imaging characteristics and to explore the clinical management of pancreatic duct stones. Methods The imaging characteristics and outcomes of different clinical management of 43 cases of pancreatic duct stones were retrospectively analyzed. Results In this group of patients with pancreatic duct stones, 42 cases were diagnosed by imaging examination, and 1 case was diagnosed during surgery. Among the 42 cases diagnosed by imaging, 20 cases were identified by B mode ultrasonography (BUS), 10 cases by CT, and 10 cases by ERCP. The pancreatic duct stones were located at the head of pancreas in 10 cases, at the body and tail of pancreas in 29 cases, and from the head to the tail of pancreas in 4 cases. Twenty patients with single pancreatic duct stones received conservative medical therapy, 6 patients with pancreatic duct stones located at the head of pancreas received endoscopic intervention therapy and 17 patients with multi pancreatic duct stones were successfully treated by surgery. Conclusions BUS, CT and ERCP are efficient means for diagnosing pancreatic duct stones. Choosing an appropriate management strategy based on the number, location and size of the stones is important for the successful treatment of pancreatic duct stones.