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目的比较B超、CT、MRCP、ERCP及肿瘤标记物检查对恶性阻塞性黄疸的评估价值。方法回顾性分析112例确诊为恶性阻塞性黄疸病人的病例,分别比较B超、CT、MRCP、ERCP及肿瘤标记物在这些病例中运用的情况及对恶性阻黄的病因判断、定位诊断和手术方式选择的价值。结果B超、CT、MRCP、ERCP及肿瘤标记物的运用率分别为100.0%、94.6%、83.0%、33.9%及40.2%,对病因判断的正确率为86.6%、91.5%、93.5%、97.3%、77.8%,对恶性阻黄的定位正确率为92.8%、89.7%、97.8%、94.7%。MRCP、ERCP对于手术方式的选择最有价值,肿瘤标记物+B超检查及B超+CT+MRCP检查正确率大于单用一种方法。结论B超和CT可作为疑诊为恶性阻黄的初选方法,肿瘤标记物的检查可提高阻黄判断的正确率,MRCP和ERCP对恶性阻黄的定位及病因评估价值最高。对恶性阻黄的术前评估应配合各项检查,循证决策。
Objective To compare the diagnostic value of B ultrasound, CT, MRCP, ERCP and tumor markers in the diagnosis of malignant obstructive jaundice. Methods The clinical data of 112 patients diagnosed as malignant obstructive jaundice were retrospectively analyzed. The application of B ultrasound, CT, MRCP, ERCP and tumor markers in these cases and the etiological diagnosis, location diagnosis and operation of malignant yellowing were compared The value of the way choice. Results The positive rates of B ultrasound, CT, MRCP, ERCP and tumor markers were 100.0%, 94.6%, 83.0%, 33.9% and 40.2% respectively, and the correct rates of diagnosis were 86.6%, 91.5%, 93.5% and 97.3 %, 77.8% respectively. The accuracy of localization of malignant yellowing was 92.8%, 89.7%, 97.8% and 94.7% respectively. MRCP, ERCP for the most valuable choice of surgical approach, tumor markers + B ultrasound examination and B + CT + MRCP examination accuracy rate is greater than a single method. Conclusions B-ultrasound and CT can be used as the primary method for the diagnosis of malignant yellow-blocking. The detection of tumor markers can improve the accuracy of yellow-rejection judgment. MRCP and ERCP have the highest value for the localization and etiology of malignant yellowing. Preoperative evaluation of malignant yellow should cooperate with the inspection, evidence-based decision-making.