腹部B超、CT和核磁胰胆管成像检查诊断肝外胆管结石的对比研究

目的评价超声、腹部CT（CT）和核磁胰胆管成像（MRCP）三种非侵人性检查方法在肝外胆管结石确诊中的应用价值。方法选择2001年1月-2007年12月在我院消化内镜中心行内镜下逆行胰胆管造影（ERCP）确诊的肝外胆管结石患者261例，并比较B超、CT和MRCP检查对胆外胆管结石的显示率并进行统计学分析。结果ERCP确诊胆总管结石患者261例，B超、CT和MRCP对胆总管结石的显示率分别为41．7％、55．6％和81．5％，两两比较有显著性差异（P〈0．05）；B超检查肝外胆总管内径≤0．8cm的胆总管结石患者共有47例，B超、CT和MRCP对胆总管无扩张胆总管结石的显示率分别为21％、30．8％和56％，B超与CT检查显示率比较无显著性差异（P〉0．05），与MRCP比较有非常显著性差异（P〈0．01）。结论诊断肝外胆管结石时，MRCP明显优于CT和B超检查，尤其肝外胆管无扩张的患者，B超和CT检查有一定局限性。

Comparative Study in Extrahepatic Choledocholithiasis Diagnosing with Ultrasound, CT and MRCP

Objective To evaluate the application of ultrasound, CT and MRCP in demonstration of extrahepatic choledocholithiasis. Method 261 patients （ range from 24 to 85 years old, mean age 62.8 years） with extrahepatic choledocholithiasis were diagnosed in our digestive endoscopic center from Jan 2001 to Dec 2007. Fhe indication ratio of ultrasound, CT and MRCP was calculated and compared. Result Extrahepatic cho edocholithiasis were diagnosed with ultrasound, CT and MRCP images in 41.7% （105/ 252） ,55.6% （35/63） and 81.5% （ 123/151, P 〈 0. 05 ）, respectively. In 47 patients, ductus choledochus,diameters were smaller than or equal to 0.8 cm,the sensitivities were 21% ,30.8% and 56% for ultrasound,CT and MRCP respectively,The sensitivity of MRCP was significantly higher than that of ultrasound. Conclusion CT and ultrasound are limited in diagnosing extrahepatic choledocholithiasis, especially in normal ductus choledochus.