内镜超声检查对胆总管结石的诊断价值  

Diagnostic significance of endoscopic ultrasonography in common bile duct stones

作　　者：年卫东[1] 张齐联[1] 梁晋雨[1] 

机构地区：[1]北京大学第一医院外科,100034

出　　处：《中华消化内镜杂志》2005年第1期16-18,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的 探讨内镜超声检查(EUS)对胆总管结石的诊断价值。方法 回顾性总结近3年 来术前B超、CT等检查未能确定胆总管结石而行EUS并经内镜乳头切开术(EST)取石或手术治疗证 实者资料,共45例。结果 45例中,EUS诊断胆总管结石43例,另2例诊断胆管轻度扩张,经EST取 出高位胆管小结石;EUS诊断胆总管结石肯中,2例分别经EST和手术(合并胆囊结石),胆管内未见 结石。其敏感度为95％,阳性预测值为95％。结石最大1.2cm,最小0.3cm,其中≤0.5cm者26例。 45例中B超诊断4例可疑胆总管末端结石,2例怀疑壶腹周围占位性病变。CT诊断3例可疑胆总管 结石,1例怀疑壶腹占位性病变。结论 EUS在诊断胆总管结石方面,不论胆管是否扩张,不论结石 大小,都明显优于B超和CT,尤其是小结石,可与ERCP相媲美,而比ERCP更少侵袭性,更安全。Objective To study on the effectiveness of endoscopic ultrasonography (EUS) in diagnosing common bile duct (CBD) stones. Methods Accuracies for the diagnosis of choledocholithiasis by abdominal ultrasonography ( B-US) and computed tomography (CT) are compared with those by EUS in 45 patients. Final diagnosis is determined by endoscopic retrograde cholangiography ( ERC) with or without sphincterotomy ( EST) or operative exploration. Results Forty-three out of 45 patients with choledtx-holithia sis were diagnosed by EUS, of them 2 patients with slight dilation of common bile duct in which stones were confirmed in the proximal part of common bile duct by EST. In 2 out of 43 patients EST and operation diagnosed cholecystolithiasis instead of choledocholilhiasis. The sensitivity and the positive predictive value are both 95%. With 41 patients choledocholithiasis were confirmed by EUS, the sizes of stone were diameter ≥ 10mm in 5 patients, 6-9 mm in 10 patients and ≤5mm in 26 patients. Four out of 45 patients were suspected to have CBD stones and 2 patients had tumor in periampullar area by B-US. Three patients were diagnosed to have CBD stone and 1 patient was suspected to have tumor in peri-ampullar area by CT. Conclusions EUS appears to be the best diagnostic tool for the diagnosis of choledocholithiasis compared with other noninvasive procedures such as B-US and CT. EUS is at least as sensitive as ERC especially in diagnosis of small CBD stones.

关 键 词：内镜超声检查 胆总管结石 诊断 胆管轻度扩张 

分 类 号：R445.1[医药卫生—影像医学与核医学]