【摘要】 目的:探讨MSCT联合三维重建技术在诊断胆总管结石中的价值。方法:回顾性分析2019年1月至2020年11月我院收治的56例疑似胆总管结石患者的临床资料,所有患者均行CT及超声检查,观察胆总管结石大小、位置及胆总管扩张程度。以经皮内镜胰胆管造影(ERCP)或手术结果为"金标准",计算2种检查方式诊断胆总管结石的诊断效能,并对其诊断结果的一致性行Kappa检验。按结石大小和分布位置比较2种检查方式对胆总管结石的阳性检出率。结果:MSCT+三维重建诊断胆总管结石的敏感性、特异性及正确率分别为95.83%、 87.50%及94.64%;超声诊断胆总管结石的敏感性、特异性及正确率分别为79.17%、 75.00%及78.57%。超声诊断胆总管结石结果与ERCP诊断结果一致性一般(Kappa=0.482), MSCT+三维重建诊断胆总管结石结果与ERCP诊断结果一致性较好(Kappa=0.792)。对直径大于0.5cm及以上结石,MSCT+三维重建与超声2种检查方式之间敏感性、特异性、正确率及Kappa值差异均无统计学意义(P>0.05);对直径小于0.5 cm结石,2种检查方式之间敏感性、特异性、正确率及Kappa值差异均有统计学意义(P<0.05)。对位于十二指肠上段和后段的结石,2种检查方式之间阳性率差异均无统计学意义(P>0.05);而位于胰腺段和十二指肠壁内段的结石,2种检查方式之间阳性率差异均有统计学意义(P<0.05)。结论:MSCT+三维重建技术在诊断胆总管结石方面较超声具有更高的敏感性、特异性及正确率,特别是对于微小结石或位于十二指肠壁内段和胰腺段的结石诊断效能更佳,阳性检出率更高,值得临床推广使用。更多还原

【Abstract】 Objective: To explore the value of MSCT combined with three-dimensional reconstruction in the diagnosis of common bile duct stones.Methods: The clinical data of 56 cases of suspected common bile duct stones in our hospital from Jan 2019 to Nov2020 were retrospectively analyzed. All patients underwent CT and ultrasound examination to observe the size, location and expansion degree of common bile duct stones. The diagnostic efficiency of the two methods in the diagnosis of common bile duct stones was calculated with the “ gold standard” of percutaneous endoscopic retrogradecholangiopancreatography( ERCP) or surgical results.According to the size and distribution of the stones, the positive detection rates of the two methods were compared.Results: The sensitivity, specificity and accuracy of MSCT + three-dimensional reconstruction in the diagnosis of common bile duct stones were 95. 83%, 87. 50% and 94. 64%, respectively. The sensitivity, specificity and accuracy of ultrasound were 79. 17%, 75. 00% and78. 57%, respectively. The results of ultrasound diagnosis of common bile duct stones were generally consistent with those of ERCP(Kappa= 0. 482), and MSCT +three-dimensional reconstruction diagnosis of common bile duct stones were well consistent with those of ERCP( Kappa = 0. 792). For stones ≥ 0. 5 cm in diameter, there were no statistically significant differences in sensitivity,specificity, accuracy and Kappa value between MSCT+three-dimensional reconstruction and ultrasound(P>0. 05). For stones <0. 5 cm in diameter, there were statistically significant differences in sensitivity, specificity, accuracy and Kappa value between the two examination methods(P< 0. 05). For stones located in the upper and posterior segments of duodenum, there was no statistically significant difference in the positive rate between the two examination methods(P>0. 05), while for stones located in the pancreatic segment and the inner wall of duodenum, there was a statistically significant difference between the two examination methods(P<0. 05).Conclusion: The MSCT combined with three-dimensional reconstruction technique has higher sensitivity, specificity,accuracy and positive detection rate than ultrasound in the diagnosis of common bile duct stones, especially for microscopic stones or stones located in the inner wall of duodenum and pancreatic segment, which is worthy of clinical promotion.更多还原