Application of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in biliary obstruction
磁共振胰胆管成像与经内镜逆行胰胆管造影术在胆道梗阻疾病中的应用

摘要

背景和目的：胆管梗阻疾病是临床上一种常见疾病，MRCP和ERCP在胆道梗阻疾病的诊治中起到十分重要的作用。本研究探讨MRCP和ERCP对胆道梗阻疾病的定位定性诊断和治疗效果。方法 回顾性分析2022年10月至2024年10月期间诊断胆道梗阻的患者进行MRCP检查，并行ERCP治疗术。根据患者的临床特征分为黄疸组和非黄疸组，分析两组患者临床特征、治疗效果和定位定性诊断准确率。结果 收集78例胆道梗阻进行MRCP检查和ERCP治疗的患者，黄疸组和非黄疸组各39例。黄疸组的术后总胆红素水平和ALT水平均较术前明显下降，差异有显著性，而非黄疸组的术后总胆红素和ALT水平较术前变化不明显，差异无显著性。本研究中胆总管结石58例，胰腺癌3例，胆管癌2例，肝癌2例，胆管炎性狭窄7例，乳头炎性狭窄3例，壶腹部肿瘤3例。在定位诊断方面，黄疸组中，MRCP定位诊断准确率87.18%，ERCP定位诊断准确率94.87%，两种方法合并（MRCP+ERCP）的定位诊断准确率97.44%；非黄疸组中，MRCP定位诊断准确率82.05%，ERCP定位诊断准确率89.74%，两种方法合并（MRCP+ERCP）的定位诊断准确率94.87%。在定性诊断方面，黄疸组中，MRCP定性诊断准确率82.05%，ERCP定性诊断准确率87.18%，两种方法合并（MRCP+ERCP）的定性诊断准确率92.31%。非黄疸组中，MRCP定性诊断准确率82.05%，ERCP定性诊断准确率87.18%，两种方法合并（MRCP+ERCP）的定性诊断准确率92.31%。提示MRCP联合ERCP对胆道梗阻的定位和定性诊断准确率较高。结论 在胆道梗阻疾病的诊断方面，MRCP和ERCP各有优缺点，两者取长补短，MRCP联合ERCP可以一定程度提高胆管梗阻的定位诊断和定性诊断准确率。在治疗方面，黄疸组患者ERCP术后的胆红素水平和谷丙转氨酶水平改善，效果良好，提示合并黄疸的胆道梗阻患者ERCP效果更优。

Abstract

Background and objective: Biliary obstruction is a common clinical disease, and MRCP and ERCP play an important role in the diagnosis and treatment of biliary obstruction. study explores the localization, qualitative diagnosis, and treatment effects of MRCP and ERCP on biliary obstruction diseases.
Methods Retrospective analysis of patients diagnosed with biliary obstruction who underwent MRCP examination and ERCP treatment from October 2022 to October2024. The patients were divided into jaundice group and non-jaundice group according to their clinical characteristics. The clinical characteristics, treatment, and accuracy of localization and qualitative diagnosis of the two groups were analyzed.
Results A total of 78 patients with biliary obstruction who underwent MRCP examination and ERCP treatment were collected, with 39 cases in jaundice group and 39 cases in the non-jaundice group. The total bilirubin level and ALT level in the jaundice group were significantly lower than those before surgery, with significant differences, while total bilirubin and ALT levels in the non-jaundice group did not change significantly after surgery, with no significant differences. In this study, there were 58 cases of common bile duct stones, 3 cases of pancreatic cancer, 2 cases of cholangarcinoma, 2 cases of hepatocellular carcinoma, 7 cases of inflammatory stricture of the bile duct, 3 cases of inflammatory stricture the papilla, and 3 cases of ampullary tumors. In terms of localization diagnosis, in the jaundice group, the accuracy rate of localization diagnosis by MRCP was 87.18 by ERCP was 94.87%, and by the combination of both methods (MRCP ERCP) was 97.44 In the non-jaundice group, the accuracy rate of localization diagnosis by MRCP was 82.05%, by ERCP was 8.74%, and by the combination of both methods (MRCP ERCP) was 94.87%.In terms of qualitative diagnosis, in the jaundice group, the accuracy rate of qualitative diagnosis of MRCP was 82.0%, that of ERCP was 87.18%, and that of the combination of the two methods (MRCP ERCP) was 9231%. In the non-jaundice group, the accuracy rate of qualitative diagnosis of MRCP was 82.05%, that of ER was 87.18%, and that of the combination of the two methods (MRCP ERCP) was 92.31%. indicates that the combination of MRCP and ERCP has a high accuracy rate for the localization and qualitative diagnosis of biliary obstruction.
Conclusion   In the diagnosis of biliary obstruction diseases, MRCP and ERCP have their own advantages and disadvantages. By combining the strengths of both, accuracy of localization and qualitative diagnosis of biliary obstruction can be improved to some extent. In terms of treatment, the bilirubin and ALT levels in theundice group improved significantly after ERCP, indicating that ERCP is more effective in patients with biliary obstruction complicated with jaundice.