影像检查在恶性黄疸诊断和鉴别诊断中的价值

目的：分析胃肠造影、Ｂ超、ＣＴ和内镜逆行胰胆管造影（ＥＲＣＰ）在恶性黄疸诊断和鉴别诊断中的作用。方法：对８３例恶性黄疸包括胰腺癌、肝外胆管癌和壶腹癌分别进行胃肠造影、Ｂ超、ＣＴ和ＥＲＣＰ检查，分析四种影像学检查的诊断阳性率和正确率，不同恶性肿瘤的特异性检查方法。结果：Ｂ超为安全、简便的检查方法，可作为诊断的首选检查，诊断阳性率为９７６７％，诊断正确率为６０６９％，特别对壶腹癌诊断正确率达８１８２％，接近于ＣＴ和ＥＲＣＰ。ＥＲＣＰ对恶性黄疸检查阳性率为９８４８％，总的诊断正确率为８８７２％，且假阳性和假阴性均较低，特别对胆总管下段病变如壶腹癌、胰头癌等的定性明显优于ＣＴ和Ｂ超。ＣＴ的诊断阳性率为９２５９％，正确率为８６１６％，同时能显示出肿瘤及其周围组织情况。胃肠造影有较高的假阳性和假阴性率，对恶性黄疸检查敏感性较低。结论：Ｂ超和ＣＴ均为无创伤性检查，可作为恶性黄疸常规检查方法，并可了解肿瘤及其周围组织情况。ＥＲＣＰ可作为Ｂ超和ＣＴ的进一步检查方法。胃肠造影不能作为恶性黄疸诊断和鉴别诊断的必需检查。

VALUE OF IMAGE EXAMINATION IN THE DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF MALIGNANT JAUNDICE

Objective: To compare the value of image examination in the differential diagnosis of malignant jaundice. Methods: 83 cases of malignant jaundice were examined by the barium meal examination B-ultrasonographyCT and ERCP. Four kinds of image examination were analysed in diagnosis and differential diagnosis of malignant jaundice. Results: B-ultrasonography acted as a method of diagnosis for the first time because of safe and simplicity. Its positive rate was 97.67% and correct rate of diagnosis was 60.69%. Positive rate of endoscopic retrograde cholangiopancreatography(ERCP) was 98.48% and correct rate was 88.72% in diagnosis of malignant jaundice. Its false positive and negative rate were more lower and ERCP was superior to B-ultrasonography and CT in diagnosis of diseases of lower common bile duct such as papillary cancercarcinoma of the pancreas and etc. CT was a non-traumatic examination and its positive rate was 92.59% and correct rate was 86.16%. The largest advantage of CT was able to show candition of cancer and surrounding tissue at the same time. It was not essential that barium meal examination act as a method of diagnosis of malignant jaundice because of its false positive and negative rate was very high. Conclusion: B-ultrasonography and CT were non-traumatic examination and may act as a routine method of differential diagnosis. They may show condition of cancer and surrounding tissue. ERCP may act as a method of examination after B-ultrasonography and CT.