【摘要】 目的探讨ERCP在临床怀疑胰腺癌患者中的诊断价值及比较ERCP与US和CT对胰腺癌诊断的意义。方法以病理诊断为依据,对行44例临床怀疑胰腺癌患者进行ERCP与US和CT比较研究。结果32例胰腺癌ERCP的X光片表现有主胰管近端狭窄与远端扩张14例(43.5%),主胰管截断现象5例(15.63%),主胰管移位例(9.37%),“双管征”8例(25%),胰腺内斑点状造影剂潴留2例(6.25%),正常胰管3例(9.38%);ERCP、US和CT对44例临床怀疑胰腺癌患者的特异性和敏感性分别为83.33%、90.63%,25%、65.63%和41.67%、84.38%。结论①胰腺癌的ERCP有胰管扩张、狭窄、中断和移位等特征性表现,但正常胰管影像不能除外胰腺癌的诊断;②ERCP对胰腺癌诊断的特异性和敏感性均较CT和US为优;③ERCP能直视乳头部及上消化道的病变并可活检组织,对胰腺癌的鉴别诊断非常重要;④ERCP对胰头癌引起胆道梗阻可放置胆道支架以减退黄疸,延长患者的生存期。更多还原

【Abstract】 Objective To evaluate the clinical significance of ultrasonography[US],computed tomography[CT]and endocscopic retrograde cholangiopancreatography[ERCP] in diagnosis of pancreatic carcinoma. Methods we performed ERCP,US and CT in 44 cases with suspected pancreatic carcinoma in our hospital from January 2003 to 2005,All 44cases were received surgical treatment and their diagnosis was confirmed pathologically. Results In 32 cases of pancreatic cancer,ERCP showed that fourteen cases had stenosis of proximal with dilation of distal pancreatic duct, that 5 cases had amputation of pancreatic duct.3cases had displacement of pancreatic duct, that 8 cases had “double duct” sign, that 2 cases had invaded pancreatic parenchyma and 3 cases had normal pancreatic duct.Based on results of 44 cases with suspected pancreatic carcinoma,the sensitivity and specificity of ERCP were 83.33%and 90.63%.Those of US were 25%、65.63%.Those of CT were 41.67%、84.38%. Conclusion ①There are specific ERCP features such as dilation,stenosis,amputation and displacement of pancreatic duct in pancreatic carcinmoma. But with normal pancreatic duct detected by ERCP, pancreatic carcinoma cannot be ruled out.②Both specificity of sensitivity of pancreatic cancer can be better by ERCP than by US and CT.③ERCP examination can find papilla lesion and digestive tract lesion and get histopathological diagnosis,which is very important for differential diagnoses.④We can set up biliary stent through ERCP in bile duct obstruction caused by carcinoma of pancreatic head. This procedure can decrease serum bilirubin and prolong survival time.更多还原