【摘要】：目的:對磁共振胰膽管造影(Magnetic Resonance Cholangio pancreatography,MRCP)、超聲內(nèi)鏡(endoscopic ultrasonography,EUS)及電子計算機斷層掃描(Computed Tomography,CT)診斷膽總管結石的診斷效能進行系統(tǒng)評價及meta分析。方法:按照循證醫(yī)學診斷學實驗的篩選方法,檢索1989-2016年PUbmed、OVID、Medine數(shù)據(jù)庫中關于MRCP、EUS、CT診斷膽總管結石的文獻資料,同時檢索中文數(shù)據(jù)庫CNKI、萬方數(shù)據(jù)庫,對篩選文獻中3種診斷方法的相關數(shù)據(jù)和指標分別進行Meta分析,合并敏感度及特異度,繪制受試者工作曲線(summary reciever operating characteristic,SROC),計算曲線下面積(AUC)及Q*值,比較各自的診斷價值。結果:共篩選出21篇文獻,包含25組研究,其中13組關于MRCP,8組關于EUS,4組關于CT。Meta分析的結果表明:MRCP、EUS、CT診斷的敏感度分別為0.91、0.95、0.83,特異度分別為0.97、0.96、0.88;SROC曲線下面積(area under curve,AUC)分別為0.9838、0.9897、0.9249,Q*值分別為0.9447、0.9578、0.8591。3種檢查方法的敏感度相似無明顯差異,特異度MRCP及EUS較CT稍高,AUC及Q*值均較高。結論:3種檢查方法均可廣泛運用于臨床,CT是目前快速診斷膽總管結石的常用方法,創(chuàng)傷較小,MRCP作為目前無創(chuàng)的方法,準確性較高,但檢查時間長。超聲內(nèi)鏡準確性較高,有一定侵入性,結果可受操作者技術的影響。
[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.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R575.62

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