经皮肝穿刺胆道造影诊断胰胆管合流异常的价值

目的 探讨经皮肝穿刺胆道造影(PTC)诊断胰胆管合流异常(PBM)的临床价值及可行性,总结其影像特征.方法 回顾性分析连续的363例因阻塞性黄疸PTC下行介入治疗患者的临床及影像资料,并根据病例入选标准筛选出资料完整、胰管显影的病例.通过影像测量胆胰共同管长度、直径,汇合处胰胆管直径、汇合角度等,并经校正得到实际数值,结合PBM诊断标准进行诊断.采用t检验比较测量值与正常值有无统计学意义,采用独立样本秩和检验分析测量的胆胰共同管长度、汇合角度与十二指肠乳头位置的关系.结果 本组病例根据PTC结果共确诊PBM 38例,检出率为10.5%(38/363);PBM患者共同管长度为(12.6±7.9)mm,明显高于正常的6 mm(t=5.15,P<0.05).汇合处胆总管直径、胰管直径、共同管直径分别为(3.7±1.9)、(2.4±1.3)、(3.3±1.4)mm,与正常值(分别为6、3、2 mm)比较差异无统计学意义(t值分别为1.79、2.85、5.72,P值均>0.05).十二指肠乳头开口于降部中段1/3部位15例,共同管长度为(10.6±9.1)mm,汇合角度51.1°±28.0°;异常开口组:降部下1/3段10例、交界处8例、水平部5例,共同管长度分别为(9.9±3.7)、(18.6±8.9)、(13.9±3.5)mm,汇合角度分别为54.0°±18.6°、48.7°±12.6°、74.4°±18.5°.十二指肠乳头部位不同的患者间,共同管长度差异有统计学意义(X2=14.51,P<0.05),乳头部位距壶腹部越远,共同管越长.结论 PTC诊断PBM安全、可行,并具有一定的特征性.

The diagnostic value of percutaneous transhepatic cholangiography imaging characteristics in pancreaticobiliary maljunction

Objective To investigate the diagnostic value and feasibility of PTC diagnosis on pancreaticobiliary maljunction (IBM), and to summarize the PTC radiological characteristics of PBM. Methods Clinical findings and cholangiopancreatographic results were analyzed retrospectively for a group of consecutive 363 patients with obstructive jaundice receiving the PTCD therapy. Meanwhile the standard selected for cases and diagnostic conditions were established. The length and diameter of pancreaticobiliary common duct, the diameter of pancreatic duct and common bile duct and the confluence angle were measured respectively. The t test and rank sum test were used to analyze the result statistically. Results Thirty-eight cases were radiologicaUy diagnosed as PBM owing to the reference standard and the detection rate was 10.5% (38/363). The length of common duct was (12.6±7.9)mm. The significant difference existed between it and normal value (6ram) (t=5.15 , P <0.05). The site of duodenal papilla had influence on the length of common duct. The diameter of common bile duct, pancreatic duct and common duct near the confluence are (3.7±1.9 ) mm, (2.4±1.3) mm, (3.3±1.4 ) mm, respectively. There was no statistical difference between them and the normal value (t=1.79,2.85,5.72, P>0.05). Fifteen patients' duodenal papilla located the middle of descending duodenum. The length of common duct was (10.6±9.1)mm , the confluence angle was 51.1°±28.0°, the number of the duodenal papilla locating in the inferior 1/3 of descending duodenum, juncture , horizontal part of duodenum was 10, 8,5, respectively. The length of common duet were (9.9±3.7), ( 18.6±8.9), ( 13.9±3.5 ) mm, respectively. The confluence angle were 54.0°±18.6°、48.7°±12.6°、74.4°±18.5°, respectively . The site of duodenal papilla had significant influence on the length of common duct(X2=14.51, P <0.05). Conclusion PTC is a safe, feasible, method to diagnose PBM, and it demonstrates the characteristic findings of PBM.