ERCP结合MSCT对肝外胆管梗阻性病变病因分析及微创治疗

摘要

Objective To assess the value of ERCP and MSCT on extrahepatic biliary obstructive lesions and minimally invasive treatment plan using ERCP.Methods 129 patients with extrahepatic biliary obstructive lesions who were histologically diagnosed underwent abdominal ERCP and MSCT. The findings for the ERCP and MSCT and minimally invasive treatment plan were noted.Results There is an accuracy of 92.2% for location value and 87.6% for qualitative diagnosis in extrahepatic biliary obstructive lesions using ERCP, and an accuracy of 82.9% for location value and 80% for qualitative diagnosis using CT. There is an achievement ratio of 95.3% for the intubation tube in 117 patients(90.7%, 117/129) undergone minimally invasive treatment using ERCP.Conclusion There was a high diagnostic value for extrahepatic biliary obstructive lesions using ERCP combined with MSCT. Remedial ERCP was one of excellent minimally invasive treatment for extrahepatic biliary obstructive lesions.%目的 探讨ERCP及MSCT对肝外胆管梗阻性病变不同病因的定位定性诊断价值及ERCP微创治疗方案.方法 回顾性分析2010年2月~2014年6月间经手术病理及ERCP组织活检病理证实的129例患者的ERCP及MSCT影像学表现、ERCP微创治疗方案,并与手术所见对照分析.结果 ERCP对肝外胆管病变定位诊断准确率92.2%,定性诊断准确率87.6%,CT定位诊断准确率82.9%,定性诊断准确率80%,术中实施镜下治疗117例,治疗病例占90.7%,插管成功率95.3%.结论 ERCP与MSCT结合对肝外胆管梗阻性病变具有很高的诊断价值,治疗性ERCP技术微创、安全、并发症少,是肝外胆管梗阻性病变的最佳微创治疗方案之一,ERCP术中选择性插管及术后ENBD能有效预防和降低术后急性胰腺炎、高淀粉酶血症等并发症.