MRCP、超声内镜、CT在胆总管结石诊断中的应用价值

发布时间：2018-12-28 12:49

【摘要】：目的:对磁共振胰胆管造影(Magnetic Resonance Cholangio pancreatography,MRCP)、超声内镜(endoscopic ultrasonography,EUS)及电子计算机断层扫描(Computed Tomography,CT)诊断胆总管结石的诊断效能进行系统评价及meta分析。方法:按照循证医学诊断学实验的筛选方法,检索1989-2016年PUbmed、OVID、Medine数据库中关于MRCP、EUS、CT诊断胆总管结石的文献资料,同时检索中文数据库CNKI、万方数据库,对筛选文献中3种诊断方法的相关数据和指标分别进行Meta分析,合并敏感度及特异度,绘制受试者工作曲线(summary reciever operating characteristic,SROC),计算曲线下面积(AUC)及Q*值,比较各自的诊断价值。结果:共筛选出21篇文献,包含25组研究,其中13组关于MRCP,8组关于EUS,4组关于CT。Meta分析的结果表明:MRCP、EUS、CT诊断的敏感度分别为0.91、0.95、0.83,特异度分别为0.97、0.96、0.88;SROC曲线下面积(area under curve,AUC)分别为0.9838、0.9897、0.9249,Q*值分别为0.9447、0.9578、0.8591。3种检查方法的敏感度相似无明显差异,特异度MRCP及EUS较CT稍高,AUC及Q*值均较高。结论:3种检查方法均可广泛运用于临床,CT是目前快速诊断胆总管结石的常用方法,创伤较小,MRCP作为目前无创的方法,准确性较高,但检查时间长。超声内镜准确性较高,有一定侵入性,结果可受操作者技术的影响。
[Abstract]:Objective: to evaluate the diagnostic efficacy of magnetic resonance cholangiopancreatography (Magnetic Resonance Cholangio pancreatography,MRCP), endoscopic ultrasonography (endoscopic ultrasonography,EUS) and computed tomography (Computed Tomography,CT) in the diagnosis of choledocholithiasis. Methods: according to the screening method of Evidence-based Medicine Diagnostic experiment, the literature about MRCP,EUS,CT diagnosis of choledocholithiasis in PUbmed,OVID,Medine database from 1989 to 2016 was searched, and the Chinese database CNKI, Wanfang database was also retrieved. The relevant data and indexes of three diagnostic methods in the screening literature were analyzed by Meta, sensitivity and specificity were combined, subjects' operating curve (summary reciever operating characteristic,SROC) was drawn, and area (AUC) and Q * value under the curve were calculated. To compare their diagnostic value. Results: a total of 21 articles were selected, including 25 groups of studies. The results of CT.Meta analysis of 13 groups about MRCP,8 group and EUS,4 group showed that the diagnostic sensitivity of MRCP,EUS,CT was 0.91% 0.95% 0.83%, respectively. The specificity was 0.97, 0.96 and 0.88, respectively. The area under SROC curve (area under curve,AUC) was 0.98380.897U 0.9249Q*, respectively. There was no significant difference in sensitivity between the two methods. The specificity of MRCP and EUS was slightly higher than that of CT, and the values of AUC and Q* were higher than those of CT. Conclusion: all three methods can be widely used in clinical practice. CT is a common method for rapid diagnosis of choledocholithiasis. MRCP is a non-invasive method with high accuracy, but it takes a long time to detect choledocholithiasis. The accuracy of endoscopic ultrasonography is high and invasive to some extent, and the results can be affected by the operator's technique.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.62

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