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目的:评价胆道联合静脉超声造影检查在恶性梗阻性黄疸治疗中的临床价值。方法:43例患者经增强CT或MRI诊断为恶性梗阻性黄疸,在手术前行经皮经肝胆管穿刺置管,并予以常规超声、静脉超声造影和胆道超声造影检查。以手术结果为金标准,分析常规超声、静脉超声造影、胆道超声造影、胆道联合静脉超声造影对恶性梗阻性黄疸的诊断符合率。结果:43例患者中,常规超声、静脉超声造影、胆道超声造影、胆道联合静脉超声造影的诊断符合率分别为72.1%(31/43)、83.7%(36/43)、81.4%(35/43)及93.0%(40/43)。其中胆道联合静脉超声造影的诊断符合率明显优于常规超声(P=0.021),而单独的静脉或胆道超声造影与常规超声之间的差异无统计学意义(P=0.194和0.307)。结论:胆道联合静脉超声造影可全面评估梗阻部位胆管的腔内和腔外的情况,提高超声对恶性梗阻性黄疸诊断符合率,有效判断手术的可切除性,具有较好的临床价值。
Objective: To evaluate the clinical value of biliary tract combined venoarterography in the treatment of malignant obstructive jaundice. Methods: Forty-three patients were diagnosed as malignant obstructive jaundice by enhanced CT or MRI. Percutaneous transhepatic cholangiopancreatography was performed prior to surgery, and routine ultrasound, venography and biliary ultrasonography were performed. The surgical results as the gold standard, analysis of conventional ultrasound, venography, ultrasound contrast, biliary ultrasonography, biliary ultrasonography on the diagnosis of malignant obstructive jaundice coincidence rate. Results: The diagnostic coincidence rates of routine ultrasound, venous contrast, biliary ultrasonography and biliary ultrasonography were 72.1% (31/43), 83.7% (36/43) and 81.4% (35 / 43) and 93.0% (40/43). Among them, the coincidence rate of biliary ultrasonography was significantly better than that of conventional ultrasound (P = 0.021), while there was no significant difference between conventional venous or biliary ultrasonography and conventional ultrasound (P = 0.194 and 0.307). Conclusion: Biliary combined with venography can evaluate the status of intracavitary and extraluminal bile duct obstruction, improve the accuracy of ultrasonic diagnosis of malignant obstructive jaundice, and judge the resectability of the operation, which has good clinical value.