论文部分内容阅读
目的 研究ERCP结合憩室造影对Lemmel’ssyndrome的诊断价值。方法 对经ERCP内镜直视下证实的 3 9例十二指肠乳头旁憩室 (periampullarydiverticula ,PAD)病人行常规ERCP后加做PAD造影 (改进ERCP) ,评估其对PAD的检出率及PAD对胆胰管末端压迫程度的显示能力 ,对结果行观察者间一致性分析。并对PAD的胆胰系合并症进行临床分析。结果 3 9例病人发现 40个PAD ,位于乳头上方 2 6例 ,下方 4例 ,憩室内乳头 4例 ,憩室缘乳头 6例。 3 9例常规ERCP摄片显示憩室 9例 ;ERCP结合憩室造影摄片显示憩室 3 6例。 2种检查方法对PAD的检出率分别为 2 3 .0 8%、92 .3 1% ,差异具有统计学意义 ( χ2 test,Ρ <0 .0 0 1)。ERCP结合憩室造影在评判压迫程度的结果上 ,两阅片者间一致率 (Kappl值 )为 0 .718(k系数检验 ,Ρ <0 .0 1)。 2种方法显示憩室明显压迫胆胰管末端 ,从影像学上提示可能为乳头旁憩室综合征的例数比分别为 6/3 9( 15 .4% )、12 /3 9( 3 0 .8% )例。结论 ERCP结合PAD造影综合了ERCP和胃肠造影的优点 ,在一次检查中能清晰显示憩室、胆胰管及二者的解剖关系 ,有利于判断乳头旁憩室与胆胰系病变的关系及提高乳头旁憩室综合征的确诊率 ,值得在临床上提倡和推广
Objective To investigate the diagnostic value of ERCP combined with diverticulum imaging in Lemmel’s disease. Methods Forty-nine patients with periampullary diverticula (PAD) confirmed by ERCP endoscopy underwent routine ERCP plus PAD radiography (improved ERCP) to assess the detection rate of PAD and PAD The ability to display the degree of compression of the end of the biliary and pancreatic ducts, the consistency between the results of interobserver analysis. And clinical analysis of PAD pancreaticobiliary complications. Results Forty-nine patients with PAD were found in 39 patients, 26 cases located above the nipple, 4 cases below, 4 cases with diverticular papilla, and 6 cases with diverticular margin nipple. 9 cases of conventional ERCP radiography showed diverticulum in 9 cases; ERCP combined diverticulum radiography showed diverticulum 36 cases. The detection rates of PAD in the two methods were 23.08% and 92.31%, respectively (χ2 test, P <0. 001). ERCP combined with diverticular angiography in the evaluation of the degree of pressure results, the two readers of the agreement rate (Kappl value) of 0.718 (k-factor test, P <0. Two kinds of methods showed that the diverticulum was significantly pressured to the end of the bile duct and pancreatic duct, and the number of cases which showed the possibility of papillary diverticulitis was 6/3 9 (15.4%), 12/39 (30.8% % )example. Conclusion ERCP combined with PAD radiography combined with the advantages of ERCP and gastrointestinal angiography in a check can clearly show the diverticulum, pancreatic duct and the anatomical relationship between the two, is conducive to determine the relationship between papillary diverticulum and gallbladder pancreatic disease and improve the nipple Side of the diagnosis of paralytic syndrome, it is worth promoting in clinical practice and promotion