肝外胆管结石诊断中磁共振胰胆管成像的应用价值研究

姜书山

【摘要】 目的：探讨肝外胆管结石诊断中磁共振胰胆管成像的应用价值。方法：选择2019年6月-2020年6月疑似肝外胆管结石患者52例作为对象，分别进行腹部CT和磁共振胰胆管成像检查，绘制ROC曲线，分析磁共振胰胆管成像、CT在肝外胆管结石中的诊断效能。结果：52例肝外胆管结石患者经手术最终确诊34例，确诊率为65.38%。磁共振胰胆管成像诊断确诊32例，诊断灵敏度为85.29%，特异度为83.33%;腹部CT检查最终确诊28例，诊断灵敏度为73.53%，特异度为83.33%。结论：肝外胆管结石患者使用磁共振胰胆管成像技术可有效对临床患者病情诊断提供帮助，针对病情程度制定相应的治疗措施，值得推广应用。

【关键词】 肝外胆管结石 临床诊断 磁共振胰胆管成像 漏诊率 腹部CT

[Abstract] Objective： To explore the application value of magnetic resonance cholangiopancreatography in the diagnosis of extrahepatic bile duct stones. Method： A total of 52 patients with suspected extrahepatic bile duct stones from June 2019 to June 2020 were selected as subjects. Abdominal CT and magnetic resonance cholangiopancreatography were performed respectively. ROC curve was drawn to analyze the diagnostic efficacy of magnetic resonance cholangiopancreatography and CT in extrahepatic bile duct stones. Result： The total of 52 patients with extrahepatic bile duct stones were finally diagnosed by surgery of 34 cases （65.38%）. Magnetic resonance cholangiopancreatography confirmed 32 cases， the sensitivity and specificity were 85.29% and 83.33% respectively. 28 cases were confirmed by abdominal CT， the sensitivity and specificity were 73.53% and 83.33% respectively. Conclusion： The application of magnetic resonance cholangiopancreatography in patients with extrahepatic bile duct stones can effectively provide help for the diagnosis of clinical patients， and corresponding treatment measures should be developed according to the severity of the disease， which is worthy of popularization and application.

[Key words] Extrahepatic bile duct stones Clinical diagnosis Magnetic resonance cholangiopancreatography Missed diagnosis rate Abdominal CT

肝膽管结石属于临床中消化道疾病，多发生在肝内胆管中，且结石的性质大多为含有多量胆红素钙的混合结石，发病人群主要为30～50岁者，主要发病原因有细菌感染以及胆汁滞留等[1]。研究显示，将近20%的肝胆管结石患者存在肝胆管狭窄的现象，临床对于肝外胆管结石的检查方式有磁共振胰胆管成像技术和胸部CT等方式[2]。这两种技术都可以以数字图像的形式对退行性病变、肿瘤和体内其他不同疾病进行呈现[3]。胸部CT能够借助造影剂看清实质性脏器的病变情况，判断和识别腹腔内的感染和病变情况，但是图像的呈现方式较为单一，病灶位置容易叠加和遮挡，从而漏诊率较高。而磁共振成像技术发展于我国20世纪80年代初，该方式无须造影剂，不受操作技术的影响，并且成像清晰，操作简单，被临床广泛认可[4]。……