摘要
目的 探讨内窥镜逆行胰胆管造影（ERCP）联合胆道微结石检查在急性胆管炎中的临床价值。方法 对于54例急性胆管炎患者，行超声、CT、磁共振胰胆管造影（MRCP）常规检查及ERCP。经ERCP或内窥镜鼻胆管引流收集患者的胆汁，通过普通光和偏振光显微镜查找微结石。结果 54例患者行常规检查提示36例胆总管结石或扩张，阳性诊断率为66．67％。54例患者均行ERCP，3例ERCP插管失败。ERCP提示39例胆总管结石或扩张，阳性诊断率为76．47％。12例ERCP未见明显异常的患者中，9例在显微镜下检查有胆道微结石，ERCP联合胆道微结石检查的阳性诊断率为94．12％，与常规检查和ERCP比较，差异有统计学意义（P〈0．05）。结论ERCP联合胆道微结石检查可以提高急性胆管炎的阳性诊断率。临床上不明原因的急性胆管炎与胆道微结石密切相关。
Objective To study the clinical application of endoscopic retrograde cholangiopancreatography（ERCP） combined with bihary microlithiasis exploration in acute cholangitis. Methods The clinical data of consecutive 54 cases of acute cholangitis were analyzed. Before ERCP, all cases were examined by routine examinations, including abdominal ultrasonography, CT or magnetic resonance cholangiopancreatography（MRCP）. The bile was collected through ERCP or endoscopic nasobiliary drainage （ENBD）, then all the samples were checked by polarization microscope. Results Thirty-six cases （66.67%） out of 54 patients with common bile duct （CBD） stones or dilation of common bile duct were diagnosed by routine examination. ERCP was performed in all patients, only 3 cases failed, and the rest were successful. Through ER- CP, 39 cases with CBD stones （76.47%）, 4 cases with CBD inflammatory stricture were diagnosed, and 12 cases were normal. Among the 12 cases, 9 cases were found with biliary microlithiasis by polarization microscope. The diagnostic effectiveness of ERCP combined with biliary microlithiasis exploration was highest （94.12%）, and there was significant difference between them （P 〈 0.05 ）. Conclusions It may improve the diagnostic accuracy to combine ERCP with biliary microlithiasis exploration in CBD stones. Biliary microlithiasis may play an important role in the pathogenesis in unknown aetiology acute unexplained cholangitis.
出处
《中国医师进修杂志（内科版）》
2008年第6期28-30,共3页
Chinese Journal of Postgraduates of Medicine
关键词
胆结石
显微镜检查
胆管炎
胰胆管造影术
内窥镜逆行
Cholelithiasis
Microscopy
Cholangitis
Cholangiopancreatography, endoscopic retrograde
