胰胆管汇合MRCP解剖与胰胆系疾病关系

发布时间：2018-02-12 11:22

本文关键词： 胰胆管汇合异常磁共振胆胰管成像胆系胰腺　出处：《安徽医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：研究背景及目的胰胆管汇合异常（pancreaticobiliary maljunction, PBM）指胆总管与胰管在十二指肠壁外汇合，形成“共同管”，不受Oddi括约肌控制，或胰胆管不汇合，分别进入十二指肠壁。这种先天性的解剖学上的汇合异常与胰胆系疾病的发生密切相关。以往，关于胰胆管汇合部的解剖研究多是在尸体解剖或内窥镜逆行胰胆管造影术（endoscopic retrograde choledochopancreatography，ERCP）等基础上进行的，属于有创研究。现在，随着螺旋CT（computer tomography）这一活体、无创的检查设备及图像后处理技术的迅速发展，可以清楚显示胰胆管汇合部及相邻腹腔脏器的解剖形态，为胰胆系疾病的诊断也提供了便利，但是CT扫描也存在不足，除具有一定的辐射损伤外，对于有比剂过敏倾向、梗阻性黄疸及血液中胆红素明显增高者，不宜行CT增强扫描检查。磁共振胰胆管成像技术(Magnetic ResonanceCholangiopancreatography, MRCP)的出现，不需对比剂即能获得胰胆管系统解剖和病理变化，有效弥补ERCP和CT检查的缺陷。本研究以MRCP活体解剖为基础，结合MRI图像及临床资料，探讨胰胆管汇合的分型、发生率及异常汇合与胰胆系疾病的关系。材料和方法统计2010年1月～2011年12月间，因怀疑有胰胆系疾病来我院进行磁共振成像(magnetic resonance imaging, MRI)同时行磁共振胰胆管成像检查的患者共963例，去除术后检查、复查、MRCP图像质量不佳的269例外，符合测量和诊断要求的694例为研究对象。其中男393例，女301例。三名医师对MRI及MRCP图像进行分析，诊断疾病，记录胰胆管汇合类型，判断胆总管有无扩张，测量胰胆管汇合角度、共同管长度等，应用SPSS17.0软件对所得数据进行统计学分析。结果根据胰胆管汇合部解剖形态及共同管长度，将胰胆管汇合分为正常型（453例，65.3%）和异常型（241例，34.7%），其中异常型又可分为胰管开口于胆管型即P-B型（84例）、胆管开口于胰管型即B-P型（85例）和分别开口型（72例）。在正常型和异常型两组之间，胰腺炎、胆系肿瘤、胰腺肿瘤的发生率有明显差异(P0.05)，异常型更容易发生胰胆系疾病。进一步比较异常型中的各型合并胰胆系疾病的发生率，经fisher精确检验显示，发现胆系结石胆囊炎和胰腺肿瘤的发生三组之间无显著性差异(P0.05)；B-P型和P-B型的胰腺炎明显高于分别开口型，而B-P型胆系肿瘤明显高于P-B型、P-B型明显高于分别开口型（P0.05）。正常型和异常型合并胆总管扩张的发生率相近(P0.05)，没有显著性差异。结论 PBM很容易合并胰胆系疾病，，特别是胰腺炎、胰胆系肿瘤的发生明显增多；B-P型及P-B型胆系胰腺炎发生率较高；B-P型胆系肿瘤发生率高；胰胆管异常汇合与先天性胆总管扩张发生无相关性。 MRCP检查有利于胰胆管汇合部的分型诊断，可为该部位病变的定位和定性诊断、胰胆系疾病早期诊断与预防性治疗提供重要信息。
[Abstract]:Research background and purpose. Abnormal pancreaticobiliary junction (PBM) refers to the exchange of common bile duct and pancreatic duct in the duodenum wall to form a "common duct", not controlled by the Oddi sphincter, or not confluence of the pancreaticobiliary duct, This congenital anatomic confluence is closely related to the occurrence of pancreaticobiliary diseases. In the past, the anatomical study of the confluence of the pancreaticobiliary duct was carried out mostly on the basis of autopsy or endoscopic retrograde cholangiopancreatography (retrograde), which was an invasive study. The rapid development of non-invasive examination equipment and image post-processing technology can clearly display the anatomy of the confluence of the pancreaticobiliary duct and adjacent abdominal organs, and provide convenience for the diagnosis of pancreaticobiliary diseases, but CT scan is also insufficient. In addition to radiation injury, CT enhanced scanning should not be performed for those with allergic tendency to specific agent, obstructive jaundice and increased bilirubin in blood. Magnetic Resonance cholangiopancreatography (MRCPY) was detected by magnetic resonance cholangiopancreatography (MRCPT). The anatomical and pathological changes of the pancreaticobiliary duct system can be obtained without contrast agent, and the defects of ERCP and CT examination can be effectively compensated. Based on the in vivo anatomy of MRCP, combined with MRI images and clinical data, the classification of pancreaticobiliary duct confluence was discussed. Incidence and abnormal confluence in relation to pancreaticobiliary diseases. Materials and methods. From January 2010 to December 2011, a total of 963 patients were examined with magnetic resonance magnetic resonance imaging (MRI) for suspected pancreaticobiliary diseases in our hospital. 694 patients who met the requirements of measurement and diagnosis were included in the study, including 393 men and 301 women. Three physicians analyzed the MRI and MRCP images, diagnosed the disease, recorded the type of pancreaticobiliary confluence, and judged the dilatation of the common bile duct. The confluence angle and the length of common duct were measured, and the data were analyzed statistically by SPSS17.0 software. Results. According to the anatomy of the confluence of the pancreaticobiliary duct and the length of the common duct, The confluence of pancreaticobiliary duct was divided into normal type (453 cases) and abnormal type (241 cases). Among them, there were 84 cases of pancreatic duct opening in bile duct, 85 cases of bile duct opening to pancreatic duct type (B-P type) and 72 cases of normal type. Between the two groups of type and anomaly, The incidence of pancreatitis, choledochoma and pancreatic neoplasms was significantly different (P 0.05), and the abnormal type was more likely to develop pancreaticobiliary diseases. Further more, the incidence of various types of pancreatic and biliary diseases in the abnormal type was compared, which was demonstrated by fisher accurate test. It was found that there was no significant difference in the occurrence of cholecystitis and pancreatic neoplasms among the three groups. But the incidence of B-P type choledochal tumor was significantly higher than that of P-B type P B type than that of open type P 0.05.The incidence of normal type and abnormal type of choledochal dilatation was similar to that of normal type and abnormal type of choledochus dilatation, and there was no significant difference between normal type and abnormal type (P 0.05). Conclusion. PBM is easy to be associated with pancreaticobiliary diseases, especially pancreatitis. The incidence of B-P type and P-B type biliary pancreatitis is higher than that of B-P type. There was no correlation between abnormal confluence of pancreaticobiliary duct and congenital choledochal dilatation. MRCP is helpful to the classification diagnosis of the confluence of pancreaticobiliary duct and can provide important information for the location and qualitative diagnosis of the lesions and the early diagnosis and preventive treatment of pancreaticobiliary diseases.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322

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