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目的以经内镜逆行胰胆管造影(ERCP)结果为金标准,回顾性分析纵轴超声内镜(EUS)及磁共振胆胰管造影(MRCP)检查对胆管结石的诊断率,并比较采用不同术前检查方法对ERCP+取石术(EST)术治疗急性胆源性胰腺炎(ABP)后早期情况的影响。方法回顾分析2014年1月至2016年4月南京医科大学第二附属医院治疗的60例ABP患者临床资料,分为术前单纯行MRCP检查组(单纯MRCP组)30例及术前行MRCP联合纵轴EUS检查组(MRCP+EUS组)30例,以ERCP术中观察作为金标准,入组患者均经ERCP术证实有胆管微小结石或胆泥,分析两组患者确诊率;并比较两组患者术后腹痛缓解时间、血清淀粉酶(AMY)及肝功能变化。结果单纯MRCP组确诊胆总管微小结石及胆泥共23例(76.6%),MRCP+EUS组诊断出28例(90.3%),MRCP+EUS组诊断率更高(P<0.05)。MRCP+EUS组患者较单纯MRCP组ERCP术后腹痛缓解时间明显缩短[(3.6±1.1)d vs(4.3±1.2)d,P<0.05],且MRCP+EUS组患者术后5 d AMY、总胆红素(TBIL)、谷氨酰转移酶(GGT)、谷丙转氨酶(ALT)均较单纯MRCP检查者明显降低,差异有统计学意义(P均<0.01)。结论 ERCP术前行MRCP联合纵轴EUS检查对判断胆总管内泥沙样结石方面更加精确。
Objective To retrospectively analyze the diagnostic value of longitudinal endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) for bile duct stones by endoscopic retrograde cholangiopancreatography (ERCP) and compare the results with different The effect of preoperative examination on the early stage after ERCP + stone surgery (EST) in the treatment of acute gallstone pancreatitis (ABP). Methods The clinical data of 60 patients with ABP treated at the Second Affiliated Hospital of Nanjing Medical University from January 2014 to April 2016 were retrospectively analyzed. The patients were divided into preoperative MRCP group (MRCP group) 30 cases and preoperative MRCP group The vertical axis EUS examination group (MRCP + EUS group) 30 cases, the ERCP intraoperative observation as the gold standard, the patients were confirmed by ERCP surgery with bile duct microlithiasis or biliary mud, analysis of the two groups of patients confirmed rate; and compared two groups Postoperative abdominal pain relief time, serum amylase (AMY) and liver function changes. Results In the MRCP group, 23 cases (76.6%) were diagnosed as common bile duct microlithiasis and choledocholithiasis, 28 cases (90.3%) were diagnosed by MRCP + EUS group, and MRCP + EUS group had higher diagnostic rate (P <0.05). Compared with MRCP group, MRCP + EUS group had shorter remission time of abdominal pain after ERCP ([(3.6 ± 1.1) d vs (4.3 ± 1.2) d, P <0.05] The levels of TBIL, GGT and ALT were significantly lower than those of MRCP alone (P <0.01). Conclusion The MRCP combined with longitudinal axis EUS examination before ERCP is more accurate in judging the sediment-like stones in the common bile duct.