内镜途经下管腔内超声及细胞刷对胆管恶性狭窄的早期诊断价值探讨  

To evaluate the early diagnosis value of Intraductal US or Cytology Brushing during ERCP for malignant biliary stricture

作　　者：黄平[1] 张皞 张筱凤[1] 张啸[1] 吕文[1] 范震[1] 黄海涛[1] 

机构地区：[1]浙江省杭州市第一人民医院消化内科,浙江杭州310006 [2]浙江省杭州市西溪医院内科,浙江杭州310000

出　　处：《中国内镜杂志》2014年第4期347-351,共5页China Journal of Endoscopy

摘　　要：目的探讨内镜途经下管腔内超声及细胞刷对胆管恶性狭窄的早期诊断价值。方法对2011年1月~2012年1月72例临床可疑恶性胆管狭窄患者先行内镜逆行胰胆管造影（ERCP）,接着行术中管腔内超声（IDUS）,再行胆道细胞刷刷检送病理检查,对单一检测以及联合检测对胆管恶性狭窄早期诊断的敏感性、特异性、阳性预测值、阴性预测值及准确性作对比分析。结果与ERCP相比,IDUS在敏感性,阳、阴性预测值及准确性上均有明显优势（P〈0.05）,而细胞刷在敏感性、特异性、阳性预测值及准确性上优势明显（P〈0.05）;IDUS与细胞刷相比,各值差异无显著性（P〉0.05）。ERCP＋IDUS与ERCP＋细胞刷相比,各值差异无显著性（P〉0.05）;ERCP联合IDUS及细胞刷在敏感性、阴性预测值及准确性上优势明显（P〈0.05）,在特异性及阳性预测值上差异无显著性（P〉0.05）。结论 ERCP过程中联合IDUS及细胞刷有助于胆管恶性狭窄的早期诊断。[Objective]The aim of this study was to evaluate the value of intraductal US or cytology brushing during ERCP in the early diagnosis of malignant biliary stricture.[Methods]72 patients suspected of malignant biliary stenosis were performed ERCP firstly, then IDUS and finally cytology brushing from January 2011 to January 2012, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of all above ways were evaluated and compared.[Results]Compared with ERCP, IDUS had obvious advantages（P 0.05） in the sensitivity, positive and negative predictive value and accuracy, and cytology brushing had obvious advantages（P 0.05） in the sensitivity, specificity, positive predictive value and accuracy（P 0.05）. There were not statistical significance in all parameters between IDUS and cytology brushing or between ERCP＋IDUS and ERCP＋cytology brushing（P 0.05）. But there were obvious statistical significance in the sensitivity, negative predictive value and accuracy between ERCP＋IDUS＋cytology brushing and ERCP＋IDUS or ERCP＋cytology brushing（P 0.05）.[Conclusion]ERCP combined with IDUS and cytology brushing helps diagnose the malignant biliary stricture earlier.

关 键 词：内镜逆行胰胆管造影 管腔内超声 细胞刷 胆管恶性狭窄 

分 类 号：R735.8[医药卫生—肿瘤]