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。

Comparative diagnostic evaluation with ultrasonography,MSCT,MRCP and ERCP in patients with obstructive jaundice

Objective To compare the diagnostic accuracy of endoscopic retrograde cholangiopancreatography(ERCP) with ultrasonography,multislice spiral computed tomography(MSCT) and magnetic resonance cholangiopancreatography(MRCP) on the location and etiology of obstructive jaundice.Methods 128 patients underwent ultrasonography,MSCT and ERCP,and 35 patients underwent MRCP.Results For the diagnosis of the location of obstructive jaundice,there is no significant difference found on evaluation of intrahepatic ducts and head of pancreas diagnosed by the four methods.Although ERCP has no significant difference with MRCP in investigating extrahepatic ducts but ERCP is superior to ultrasonography and MSCT.As for the etiology of obstructive jaundice,there is no significant difference found on evaluation for gallstone,cholangitis and carcinoma of the head of pancreas diagnosed by the four methods.MRCP,MSCT and ERCP were all better than ultrasonography for the diagnosis of cholangiocarcinoma,further more,ERCP was better than ultrasonography and MSCT for duodenal papilla cancer and juxtapapillary duodenal diverticula diagnosis. Conclusion ERCP has an important value in diagnosing the location(especially extrahepatic ducts,duodenal papilla) and etiology(especially cholangiocarcinoma and duodenal papilla cancer) of obstructive jaundice.