磁共振胆胰管成像评价胰胆管汇合分型与胰腺炎发病的关系
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摘要
背景与目的
胰腺炎是一种因胰蛋白自身的消化作用而引起的胰腺疾病。病情轻重不一,重症胰腺炎可危及生命。胰腺炎病因繁多,近来有研究表明,胰胆管合流异常与胰腺疾病的发生发展有着密切的联系。随着医学影像检查技术的发展,一些疾病的诊出率也相应的提高,胆胰管合流异常就是其中的一种疾病。明确病因是诊断疾病的前提,也是做出合理的治疗方案的前提。因此,明确胆胰管合流异常是否是临床某种疾病的病因对于临床诊治至关重要。
通过磁共振胆胰管成像技术下的胆管和胰管的显示情况,观察胆管和胰管的汇合方式,根据胆管和胰管的正常解剖和异常变异情况把胆管和胰管的汇合方式划分为不同类型,探讨磁共振胆胰管成像技术下胆管和胰管各种汇合类型与胰腺炎的发病概率之间的关系,分析其对临床诊断的应用价值和治疗方案的指导意义。
资料与方法
收集本院2008年1月—2012年2月磁共振检查的226例胆胰管汇合处能够清晰显示的MRCP影像资料(237例病例资料中11例因不符合研究标准被排除在外),资料分为胰腺炎组和非胰腺炎组进行对比分析,临床诊断为胰腺炎的106例,诊断为无胰腺炎的120例作为对照组。检查采用1.5T磁共振扫描仪,加用呼吸门控,TORSOPA8通道体部线圈,所有病例均做平扫、磁共振水成像扫描及增强扫描,扫描序列包括T1WI、T2WI、M3D/FRFSE、FIESTA及LAVA序列,扫描完成后获得的图像数据传输至GE ADW4.2系统(图像工作站)应用MIP和MPR方法对图像进行处理,结合原始图像观察分析,由两位高年资丰富工作经验的影像诊断医师阅片,采用双盲法,对磁共振图像多方位多角度的观察胆管胰管汇合部的显示情况,观察正常汇合和异常汇合的情况,对胆胰管汇合部进行分型,分析汇合部分型与胰腺炎发病概率的关系,对于分型意见有分歧的,由两人讨论确定为统一的标准来分析。使用spss17.0进行统计学方面的分析,各组数据采用卡方检验及Fisher概率法进行分析统计,得出结果,分析胆管和胰管汇合部与胰腺炎的临床发病概率之间的关系。
结果
分为胰腺炎组(106例)和无胰腺炎组(120例)的226例清晰显示胆管和胰管汇合部的患者资料,根据胆胰管汇合方式分为正常汇合型和异常汇合型,其中正常型又分为A、B两型；异常汇合型分为B-P型、P-B型两型。在226例中,正常汇合类型的198例中胰腺炎组为83例,非胰腺炎组为115例；异常汇合类型的28例中胰腺炎组为23例,非胰腺炎组为5例,异常汇合分型中B-P型18例,P-B型10例。
用卡方检验对正常汇合型和异常汇合型的胆胰管汇合分型与胰腺炎的发生概率进行统计学检验,两种类型胰腺炎发生概率有显著统计学意义,异常汇合型胰腺炎发病概率高于正常汇合型,其中以异常汇合类型中B-P型异常汇合型的胰腺炎的发病概率最高。
结论
磁共振胆胰管成像可以对胆管和胰管的汇合部情况清晰显示并分型,评价分型类型与胰腺炎的发病概率之间的关系,为临床诊断及治疗提供可靠影像依据,具有较高的应用价值和临床指导意义。
Background and objective
Pancreatitis is a pancreas disease because of digestive function of the trypsin itself. IIllness severity is differ, severe acute pancreatitis can threat to life. Pancreatitis has many pathogeny, recent studies shows that the pancreaticobiliary maljunction is closely related with the occurrence and development of incidence of pancreatic diseases. Along with the development of medical imaging technology, some diseases are diagnosed rate is also improved, pancreaticobiliary maljunction is one of a kind of disease, definite pathogeny is the precondition for the diagnosis of disease, also is the premise of make reasonable treatment plan. Therefore,definite pancreaticobiliary maljunction whether clinical disease cause is very important to clinical diagnosis and treatment.
Through studying the display of bile duct and pancreatic duct under magnetic resonance,Observationt the join way of bile duct and pancreatic duct,Through to the normal anatomy and abnormal variations of the bile duct and pancreatic duct to divided into different types.thus probe into the relationship between anomalous pancreaticobiliary junction and the incidence of pancreatitis and analyze its application value to clinical diagnosis and guidance meaning to therapeutic schedule.
Materials and methods
Collected from January2008-February2012magnetic resonance imaging of226cases of biliary pancreatic duct confluence can clear display the MRCP imaging data (The data of237cases of11cases because of do not accord with standard of study were excluded), the data can be divided into acute pancreatitis group and non pancreatitis were analyzed,106cases of clinical diagnosis of pancreatitis,120cases as control group,121cases of male, female105cases, aged27-88, the average age of43.6years, Check used1.5T MRI scans, combined with respiratory gating, TORSOPA8body coil. All cases do plain scan, MRH scan and enhanced scan,Scanning sequence including T1WI, T2WI, M3D/FRFSE, FIESTA and LAVA sequence. Obtained the image date after the scan completion to transmission to the GE ADW4.2system (image workstation) application of MIP and MPR method of image processing,combined with the original image to observation and analysis, by two imaging diagnosis doctor with High qualification rich experience to reading image,reading by double-blind method, observation of the magnetic resonance imaging in different bile duct pancreatic duct confluence of display case, observation of normal and abnormal rendezvous in its case, to the bile pancreatic duct confluence of parting, analysis convergence part relation to clinical disease. For classification are difference opinion, be determined by two people discuss as a unified standard to analyze. Using spss17.0statistical aspects of the analysis, the data by chi-square test and Fisher probability analysis method of statistics, obtain the results, analysis the relationship between anomalous pancreaticobiliary junction and the incidence of pancreatitis.
Result
Divided into acute pancreatitis group (106cases) and non acute pancreatitis group (120cases) of226cases of clear display of bile duct and pancreatic duct confluence of patient information, according to the bile pancreatic duct confluence way divided into the normal combination type and exception type (The abnormal converging type were confirmed by ERCP), normal type is divided into A, B two type; Anomalies join divided into B-P and P-B two type.In226cases, normal confluence types of198cases pancreatitis group83examples, the exception group of115cases;Unusual confluence types of28cases of pancreatitis group for23cases, the exception group of5cases;In the exception type, B-P type18cases and P-B type10cases.
Using chi-square test of normal and abnormal rendezvous in bile pancreatic duct confluence parting with pancreatitis probability statistical inspection, Two types of incidence of pancreatitis have significant statistically significant,with an abnormal converging type B-P converging type pancreatitis have the highest incidence of a disease.
conclusion
MRCP can clearly display and classify the condition of the conjunction of bile duct and pancreatic duct, evaluate the relationship between the type and the incidence of pancreatitis, hence,shed light on clinical diagnose and treatment, which is of high application value and clinical guidance meaning.
胰腺炎是一种因胰蛋白自身的消化作用而引起的胰腺疾病。病情轻重不一,重症胰腺炎可危及生命。胰腺炎病因繁多,近来有研究表明,胰胆管合流异常与胰腺疾病的发生发展有着密切的联系。随着医学影像检查技术的发展,一些疾病的诊出率也相应的提高,胆胰管合流异常就是其中的一种疾病。明确病因是诊断疾病的前提,也是做出合理的治疗方案的前提。因此,明确胆胰管合流异常是否是临床某种疾病的病因对于临床诊治至关重要。
通过磁共振胆胰管成像技术下的胆管和胰管的显示情况,观察胆管和胰管的汇合方式,根据胆管和胰管的正常解剖和异常变异情况把胆管和胰管的汇合方式划分为不同类型,探讨磁共振胆胰管成像技术下胆管和胰管各种汇合类型与胰腺炎的发病概率之间的关系,分析其对临床诊断的应用价值和治疗方案的指导意义。
资料与方法
收集本院2008年1月—2012年2月磁共振检查的226例胆胰管汇合处能够清晰显示的MRCP影像资料(237例病例资料中11例因不符合研究标准被排除在外),资料分为胰腺炎组和非胰腺炎组进行对比分析,临床诊断为胰腺炎的106例,诊断为无胰腺炎的120例作为对照组。检查采用1.5T磁共振扫描仪,加用呼吸门控,TORSOPA8通道体部线圈,所有病例均做平扫、磁共振水成像扫描及增强扫描,扫描序列包括T1WI、T2WI、M3D/FRFSE、FIESTA及LAVA序列,扫描完成后获得的图像数据传输至GE ADW4.2系统(图像工作站)应用MIP和MPR方法对图像进行处理,结合原始图像观察分析,由两位高年资丰富工作经验的影像诊断医师阅片,采用双盲法,对磁共振图像多方位多角度的观察胆管胰管汇合部的显示情况,观察正常汇合和异常汇合的情况,对胆胰管汇合部进行分型,分析汇合部分型与胰腺炎发病概率的关系,对于分型意见有分歧的,由两人讨论确定为统一的标准来分析。使用spss17.0进行统计学方面的分析,各组数据采用卡方检验及Fisher概率法进行分析统计,得出结果,分析胆管和胰管汇合部与胰腺炎的临床发病概率之间的关系。
结果
分为胰腺炎组(106例)和无胰腺炎组(120例)的226例清晰显示胆管和胰管汇合部的患者资料,根据胆胰管汇合方式分为正常汇合型和异常汇合型,其中正常型又分为A、B两型；异常汇合型分为B-P型、P-B型两型。在226例中,正常汇合类型的198例中胰腺炎组为83例,非胰腺炎组为115例；异常汇合类型的28例中胰腺炎组为23例,非胰腺炎组为5例,异常汇合分型中B-P型18例,P-B型10例。
用卡方检验对正常汇合型和异常汇合型的胆胰管汇合分型与胰腺炎的发生概率进行统计学检验,两种类型胰腺炎发生概率有显著统计学意义,异常汇合型胰腺炎发病概率高于正常汇合型,其中以异常汇合类型中B-P型异常汇合型的胰腺炎的发病概率最高。
结论
磁共振胆胰管成像可以对胆管和胰管的汇合部情况清晰显示并分型,评价分型类型与胰腺炎的发病概率之间的关系,为临床诊断及治疗提供可靠影像依据,具有较高的应用价值和临床指导意义。
Background and objective
Pancreatitis is a pancreas disease because of digestive function of the trypsin itself. IIllness severity is differ, severe acute pancreatitis can threat to life. Pancreatitis has many pathogeny, recent studies shows that the pancreaticobiliary maljunction is closely related with the occurrence and development of incidence of pancreatic diseases. Along with the development of medical imaging technology, some diseases are diagnosed rate is also improved, pancreaticobiliary maljunction is one of a kind of disease, definite pathogeny is the precondition for the diagnosis of disease, also is the premise of make reasonable treatment plan. Therefore,definite pancreaticobiliary maljunction whether clinical disease cause is very important to clinical diagnosis and treatment.
Through studying the display of bile duct and pancreatic duct under magnetic resonance,Observationt the join way of bile duct and pancreatic duct,Through to the normal anatomy and abnormal variations of the bile duct and pancreatic duct to divided into different types.thus probe into the relationship between anomalous pancreaticobiliary junction and the incidence of pancreatitis and analyze its application value to clinical diagnosis and guidance meaning to therapeutic schedule.
Materials and methods
Collected from January2008-February2012magnetic resonance imaging of226cases of biliary pancreatic duct confluence can clear display the MRCP imaging data (The data of237cases of11cases because of do not accord with standard of study were excluded), the data can be divided into acute pancreatitis group and non pancreatitis were analyzed,106cases of clinical diagnosis of pancreatitis,120cases as control group,121cases of male, female105cases, aged27-88, the average age of43.6years, Check used1.5T MRI scans, combined with respiratory gating, TORSOPA8body coil. All cases do plain scan, MRH scan and enhanced scan,Scanning sequence including T1WI, T2WI, M3D/FRFSE, FIESTA and LAVA sequence. Obtained the image date after the scan completion to transmission to the GE ADW4.2system (image workstation) application of MIP and MPR method of image processing,combined with the original image to observation and analysis, by two imaging diagnosis doctor with High qualification rich experience to reading image,reading by double-blind method, observation of the magnetic resonance imaging in different bile duct pancreatic duct confluence of display case, observation of normal and abnormal rendezvous in its case, to the bile pancreatic duct confluence of parting, analysis convergence part relation to clinical disease. For classification are difference opinion, be determined by two people discuss as a unified standard to analyze. Using spss17.0statistical aspects of the analysis, the data by chi-square test and Fisher probability analysis method of statistics, obtain the results, analysis the relationship between anomalous pancreaticobiliary junction and the incidence of pancreatitis.
Result
Divided into acute pancreatitis group (106cases) and non acute pancreatitis group (120cases) of226cases of clear display of bile duct and pancreatic duct confluence of patient information, according to the bile pancreatic duct confluence way divided into the normal combination type and exception type (The abnormal converging type were confirmed by ERCP), normal type is divided into A, B two type; Anomalies join divided into B-P and P-B two type.In226cases, normal confluence types of198cases pancreatitis group83examples, the exception group of115cases;Unusual confluence types of28cases of pancreatitis group for23cases, the exception group of5cases;In the exception type, B-P type18cases and P-B type10cases.
Using chi-square test of normal and abnormal rendezvous in bile pancreatic duct confluence parting with pancreatitis probability statistical inspection, Two types of incidence of pancreatitis have significant statistically significant,with an abnormal converging type B-P converging type pancreatitis have the highest incidence of a disease.
conclusion
MRCP can clearly display and classify the condition of the conjunction of bile duct and pancreatic duct, evaluate the relationship between the type and the incidence of pancreatitis, hence,shed light on clinical diagnose and treatment, which is of high application value and clinical guidance meaning.
引文
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[1]孟翔凌；何磊；徐阿曼胰胆管合流异常的临床意义[J]中国普外基础与临床杂志2003(05)：230-232.
[2]石景森,孙学军.胰胆管合流异常与胰胆管疾病的关系[J].临床外科杂志,2007,15(8)：515-517.
[3]段体德胰胆管合流异常并发胆胰疾病的诊治问题[J].中国普外基础与临床杂志1999(02)：54-56.
[4]陈风.汪健 胰胆管合流异常及其相关疾病[J].医学综述2006(3)：432-434.
[5]段体德胰胆管合流异常并发胆胰疾病的诊治问题[J]中国普外基础与临床杂志1999(02)：379-381.
[6]Hu B;Gong B;Zhou DY Association of anomalous pancreaticobiliaryDuctal junction with gallbladder carcinoma in Chinese patients:an ERCP study[J].2003(04):679-682.
[7]Visser BC;Suh I;Way LW Congenital choledochal cysts in adults[J].2004(08) 139-142.
[8]Benhidjeb T;Mfinster B;Ridwelski K Cystic dilatation of the common bile duct:Surgical treatment and long-term results[J] 1994(09) 170-172.
[9]Yamashita Y;Abe Y;Tang Y In vitro and clinical studies of image acquisition in breath-hold MR cholangiopancreatogreaphy:1997(7):11-13.
[10]黄强.祝建波.谭庆丰.陈洪流.张发明.季国忠.范志宁中国人胆胰管汇合处的应解剖(40例尸检报告及文献分析)[J].中国内镜杂志2008(8)：503--505.
[11]Dahlstrom N;Persson A;Albiin N Contrast-enhanced magnetic resonance cholangiography with Gd-BOPTA and GdEOB-DTPA in healthy subjects[J].2007 (22):600-602.
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[20]期刊论文急性胰腺炎实验研究的现状与展望[J]中华实验外科杂志2002,19(4)：256-259
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[1]孟翔凌；何磊；徐阿曼胰胆管合流异常的临床意义[J]中国普外基础与临床杂志2003(05)：230-232.
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[3]段体德胰胆管合流异常并发胆胰疾病的诊治问题[J].中国普外基础与临床杂志1999(02)：54-56.
[4]陈风.汪健 胰胆管合流异常及其相关疾病[J].医学综述2006(3)：432-434.
[5]段体德胰胆管合流异常并发胆胰疾病的诊治问题[J]中国普外基础与临床杂志1999(02)：379-381.
[6]Hu B;Gong B;Zhou DY Association of anomalous pancreaticobiliaryDuctal junction with gallbladder carcinoma in Chinese patients:an ERCP study[J].2003(04):679-682.
[7]Visser BC;Suh I;Way LW Congenital choledochal cysts in adults[J].2004(08) 139-142.
[8]Benhidjeb T;Mfinster B;Ridwelski K Cystic dilatation of the common bile duct:Surgical treatment and long-term results[J] 1994(09) 170-172.
[9]Yamashita Y;Abe Y;Tang Y In vitro and clinical studies of image acquisition in breath-hold MR cholangiopancreatogreaphy:1997(7):11-13.
[10]黄强.祝建波.谭庆丰.陈洪流.张发明.季国忠.范志宁中国人胆胰管汇合处的应解剖(40例尸检报告及文献分析)[J].中国内镜杂志2008(8)：503--505.
[11]Dahlstrom N;Persson A;Albiin N Contrast-enhanced magnetic resonance cholangiography with Gd-BOPTA and GdEOB-DTPA in healthy subjects[J].2007 (22):600-602.
[12]Komi N,Takehara H,kunitomo K, et al. Does the type of anomalous arrangement of pancreaticobiliary ducts influence the surgery and prognosis of choledochal cyst [J]. Pediatr Surg,1992,27 (6):728-731.
[13]许宁.唐权伟.张作英.闵利.王龙.曾江忠.代小思肝胰壶腹隔膜解剖学研究及功能探讨[J].医学信息2011(1)11-12.
[14]Krishna NB;Saripalli S;Safdar R Intraductal US in evaluation of biliarystrictures without a mass lesion on CT scan or magnetic resonance imaging:significance of focal wall thickening and extrinsic compression at the stricture site[J]2007(01):20-22.
[15]Tamada K;Kanai N;Wada S Utility and limitations of intraductal ultrasonography in distinguishing longitudinal cancer extension along the bile duct from inflammatory wall chickening [J] 2001(21):453-455.
[16]Wurm P;Dixon AD;Rathbone BJ Ulcerative colitis,primary sclerosing cholangitis and celiac disease:two cases and review of the literature[J] 2003(07):569-571.
[17]Dominion L;Chiappa A;Bianchi V;Interdonato PF, Festi L, Careano G,BeneventoA, Dionigi R Infected pancreatic necrosis complicated by multiple organ failure 1997 (07):456-458
[18]于仁旭.刘林祥.马祥兴影像学检查对肝门部胆管癌的诊断价值[J].中国现代普通外科进展2010(2)：379-381.
[19]魏祥.范存雷.赵廷超.窦国胜.周玲.王淑霞MRCP与ERCP鉴别肝外胆管良恶性狭窄的对比研究[J].解剖与临床2008(1)：231-233.
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