影像检查在恶性黄疸诊断和鉴别诊断中的价值

• 作 者: 包晓君 苏秉忠 于金华
• 机 构: 包头市蒙中医院内科,内蒙古医学院第一附属医院消化内科
• 出 处: 内蒙古医学院学报
• 发表日期: 1999年02期
• 关键词: 鉴别诊断 诊断阳性率 壶腹癌 肝外胆管癌 影像检查 胰头癌 假阴性率 胆总管下段 常规检查方法 无创伤性检查

目的：分析胃肠造影、Ｂ超、ＣＴ和内镜逆行胰胆管造影（ＥＲＣＰ）在恶性黄疸诊断和鉴别诊断中的作用。方法：对８３例恶性黄疸包括胰腺癌、肝外胆管癌和壶腹癌分别进行胃肠造影、Ｂ超、ＣＴ和ＥＲＣＰ检查，分析四种影像学检查的诊断阳性率和正确率，不同恶性肿瘤的特异性检查方法。结果：Ｂ超为安全、简便的检查方法，可作为诊断的首选检查，诊断阳性率为９７６７％，诊断正确率为６０６９％，特别对壶腹癌诊断正确率达８１８２％，接近于ＣＴ和ＥＲＣＰ。ＥＲＣＰ对恶性黄疸检查阳性率为９８４８％，总的诊断正确率为８８７２％，且假阳性和假阴性均较低，特别对胆总管下段病变如壶腹癌、胰头癌等的定性明显优于ＣＴ和Ｂ超。ＣＴ的诊断阳性率为９２５９％，正确率为８６１６％，同时能显示出肿瘤及其周围组织情况。胃肠造影有较高的假阳性和假阴性率，对恶性黄疸检查敏感性较低。结论：Ｂ超和ＣＴ均为无创伤性检查，可作为恶性黄疸常规检查方法，并可了解肿瘤及其周围组织情况。ＥＲＣＰ可作为Ｂ超和ＣＴ的进一步检查方法。胃肠造影不能作为恶性黄疸诊断和鉴别诊断的必需检查。

Objective: To analyze the role of gastrointestinal angiography, B ultrasound, CT and endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and differential diagnosis of malignant jaundice. Methods: 83 cases of malignant jaundice including pancreatic cancer, extrahepatic cholangiocarcinoma and ampullary carcinoma were examined by gastroduodenoscopy, B ultrasound, CT and ERCP respectively. The diagnostic positive rate and correct rate of four kinds of imaging examination were analyzed. The specific test method. Results: B-ultrasound is a safe and easy method of examination, which can be used as the first choice of diagnosis. The positive rate of diagnosis is 9767%, the correct rate of diagnosis is 6069%, and the correct rate of diagnosis of ampullary carcinoma is 8182% , Close to CT and ERCP. ERCP positive rate of malignant jaundice examination was 9848%, the total diagnostic accuracy was 8872%, and false positives and false negatives were lower, especially for the common bile duct lesions such as ampulla, pancreatic cancer Qualitative significantly better than CT and B ultrasound. The positive rate of CT diagnosis was 9259% and the correct rate was 8616%. At the same time, the tumor and its surrounding tissues could be shown. Gastrointestinal angiography has a higher false positive and false negative rates, and is less sensitive to malignant jaundice. Conclusion: Both B-mode ultrasonography and CT are noninvasive examination, which can be used as a routine examination method for malignant jaundice and can understand the tumor and its surrounding tissue. ERCP can be used as a further examination of B-mode and CT. Gastrointestinal angiography can not be used as an essential check for the diagnosis and differential diagnosis of malignant jaundice.