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目的：比较分析腹部彩超、CT与MRCP检查在不同部位胆总管结石中的诊断价值，提高胆总管结石诊断的准确性。方法：收集2022-2024年青岛大学附属医院诊断为胆总管结石且进行腹部彩超、CT及MRCP检查的179例患者。以ERCP取石或外科手术取石为诊断标准，收集其检查结果并与术后结果进行回顾性收集比较。结果：对于胆总管结石诊断的总体准确率，腹部彩超（32.40%）显著小于CT(88.83%)及MRCP(94.41%)。三种检查对胆总管上段结石的诊断率差异无统计学意义（P>0.05），其灵敏度分别是52.78%（腹部彩超）、75.00%(CT)、83.33%(MRCP)，特异度分别是97.90%（腹部彩超）、100.0%(CT)、99.30%(MRCP)。胆总管中下段结石诊断率由低到高依次为腹部彩超、CT、MRCP，其灵敏度分别是24.55%（腹部彩超）、88.62%(CT)、94.01%(MRCP)，特异度分别是91.67%（腹部彩超）、83.33%(CT)、91.67%(MRCP)。结论：腹部彩超可作为上段胆总管结石诊断的常规检查，对胆总管中下段结石应与CT、MRCP联合应用以提高诊断的准确率。
Abstract：Objective: To compare the diagnostic value of abdominal ultrasound, CT and MRCP for common bile duct stones in order to improve the diagnostic accuracy of common bile duct stones. Methods: A total of 179 patients suspected of common bile duct stones in the Affiliated Hospital of Qingdao University from 2022 to 2024 were collected, and all of the above patients underwent abdominal ultrasound, CT and MRCP examinations. ERCP or surgical stone removal was used as the diagnostic criterion.The examination results were collected and compared with the postoperative results for retrospective analysis. Results: For the overall accuracy of the diagnosis of common bile duct stones, abdominal ultrasound(32.40%) was significantly lower than that of CT(88.83%) and MRCP(94.41%). There was no significant difference in statistics of the three tests for upper common bile duct stones(P>0.05). The sensitivities were 52.78%(abdominal ultrasound), 75.00%(CT), and 83.33%(MRCP), and specificities were97.90%(abdominal ultrasound), 100.0%(CT), and 99.30%(MRCP). For the middle and lower common bile duct stones, the diagnostic rates ranged from low to high were abdominal ultrasound, CT, MRCP.Their sensitivities were 24.55%(abdominal ultrasound), 88.62%(CT), and 94.01%(MRCP), and specificities are 91.67%(abdominal ultrasound), 83.33%(CT), and 91.67%(MRCP). Conclusion: Abdominal ultrasound can be used as a routine test for diagnosing upper common bile duct stones. For middle and lower common bile duct stones, CT and MRCP should be used in combination to improve the accuracy of diagnosis.
[1]王智峰,祝学光,刘玉兰.胆石症的诊断与治疗进展[J].临床消化病杂志, 2006(6):325-327.
[2] TABATA M, NAKAYAMA F. Bacteria and gallstones:etiological significance[J]. Dig Dis Sci, 1981, 26(3):218-224.
[3] GOODHART G L, LEVISON M E, TROTMAN B W, et al. Pigment vs cholesterol cholelithiasis:bacteriology of gallbladder stone, bile, and tissue correlated with biliary lipid analysis[J]. Am J Dig Dis, 1978, 23(10):877-882.
[4] LOTVEIT T, OSNES M, LARSEN S. Recurrent biliary calculi:duodenal diverticula as a predisposing factor[J].Ann Surg, 1982, 196(1):30-32.
[5] SCHULMAN A. Non-western patterns of biliary stones and the role of ascariasis[J]. Radiology, 1987, 162(2):425-430.
[6] LIPSETT P A, PITT H A. Acute cholangitis[J]. Surg Clin North Am, 1990, 70(6):1297-1312.
[7] MEERALAM Y, AL-SHAMMARI K, YAGHOOBI M. Diagnostic accuracy of EUS compared with MRCP in detecting choledocholithiasis:a meta-analysis of diagnostic test accuracy in head-to-head studies[J]. Gastrointest Endosc, 2017, 86(6):986-993.
[8] TAZUMA S, UNNO M, IGARASHI Y, et al. Evidencebased clinical practice guidelines for cholelithiasis 2016[J]. J Gastroenterol, 2017, 52(3):276-300.
[9] FUJITA N, YASUDA I, ENDO I, et al. Evidence-based clinical practice guidelines for cholelithiasis 2021[J]. J Gastroenterol, 2023, 58(9):801-833.
[10] VARGHESE J C, LIDDELL R P, FARRELL M A, et al.The diagnostic accuracy of magnetic resonance cholangio pancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis[J]. Clin Radiol, 1999, 54(9):604-614.
[11]吴宗杨,郑鑫,昝献峰,等.胆囊结石合并胆总管结石预测模型的研究[J].中国实用外科杂志, 2010, 30(3):214-216.
[12]赵胜利,朱传英,李秀芬.超声内镜诊断胆总管结石的临床价值分析[J].山东医药, 2010, 50(39):60-61.
[13] SIMARD R. Ultrasound imaging of orthopedic injuries[J]. Emerg Med Clin North Am, 2020, 38(1):243-265.
[14] CHENG B, CHANG T. Enhancing ultrasonic imaging with low transient pulse shaping[J]. IEEE Trans Ultrason Ferroelectr Freq Control, 2007, 54(3):627-635.
[15]崔雷雷,路萌,康洁,等.ERCP指引下sEST+球囊扩张治疗JPDD合并胆总管结石的研究[J].影像科学与光化学, 2022, 40(3):525-530.
[16]顾琤,陆孝道,于进玲,等. 531例阻塞性黄疸的四种影像学检查分析[J].肝胆胰外科杂志, 2011, 23(1):58-59.
[17]骆平.探讨MRI与CT对胆系结石的诊断价值[J].中原医刊, 2006(6):44-45.
[18] MIN J H, SHIN K S, LEE J E, et al. Combination of CT findings can reliably predict radiolucent common bile duct stones:a novel approach using a CT-based nomogram[J]. Eur Radiol, 2019, 29(12):6447-6457.
[19]任丽娟,孔延亮.腹部彩超与MRCP对胆总管结石诊断价值的比较[J].吉林医学, 2013, 34:6457-6459.
[20]何之彦,杨秀军,李建奇,等.胆胰管解剖:快速自旋回波单激发与重T2加权序列磁共振水成像对照研究[J].实用放射学杂志, 2001(1):740-742.
[21]刘怡文,张学俭,王利群,等. MSCT、MRCP、ERCP对梗阻性黄疸病因诊断的对比分析[J].实用医学杂志,2005(19):73-74.
[22]李文政,彭光春,汤恢焕,等.口服枸橼酸铁铵在胆胰系MRI中的应用价值评价[J].放射学实践, 2006(7):687-691.
[23] MANES G, PASPATIS G, AABAKKEN L, et al. Endoscopic management of common bile duct stones:european society of gastrointestinal endoscopy(ESGE)guideline[J]. Endoscopy, 2019, 51(5):472-491.
[24]樊毅,孙诚谊,喻超.数字化诊疗技术在肝内胆管结石中的应用[J].肝胆胰外科杂志, 2020, 32(8):509-513.
基本信息:
DOI：
中图分类号:R575.62;R445
引用信息:
[1]翟钰瑄,陈晓恺,任琳琳.探讨腹部彩超、CT与MRCP对胆总管结石的诊断价值[J].影像技术,2025,37(05):4-9.
基金信息:
国家自然科学基金项目（82273393）; 青岛大学医学部“青年人才助力计划”项目