超声内镜对胆总管下段狭窄性病变的诊断价值  

Diagnostic value of endoscopic ultrasonography for distal bile duct stenosis

作　　者：薄陆敏[1] 杨俊驰[2] 陈浩宇[1] 王茜[1] 金震东[1] 陈洁[1] 李兆申[1] 

机构地区：[1]第二军医大学附属长海医院消化内科,上海200433 [2]第二军医大学附属长海医院普外科,上海200433

出　　处：《中华消化内镜杂志》2017年第5期340-342,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的评估内镜超声检查术（EUS）对胆总管下段狭窄良恶性的诊断价值。方法回顾性分析2007年1月至2015年3月因胆管下段狭窄于上海长海医院消化科内镜诊疗中心行EUS的患者51例，收集其EUS、胆管腔内超声（IDUS）、ERCP下胆管细胞刷检的诊断结果及最终诊断，评估EUS对胆管下段狭窄良恶性的诊断价值。结果最终诊断恶性胆管狭窄19例，良性胆管狭窄32例。EUS与IDUS相比，对胆管下段狭窄良恶性判断的敏感度（73．7％比57．1％）、阳性预测值（73．7％比57．1％）较高（P〈0．05），特异度（84．4％比84．2％）、准确率（80．4％比76．9％）与IDUS相当。EUS诊断敏感度高于胆管细胞刷检（73．7％比50．0％），特异度（84．4％比100．0％）、准确率（80．4％比81．6％）与细胞刷检相当。EUS显示胆管腔内低回声团块的声像图特征对胆管下段恶性狭窄的诊断准确率高于胆管壁不规则增厚（100．0％比64．3％，P〈0．05）。结论对于CT／MRI未发现可解释胆管下段狭窄病变的患者，EUS对进一步判断胆管狭窄良恶性具有重要价值。Objective To study the diagnostic value of endoscopic ultrasonography （EUS）for benign and malignant bile duct stricture. Methods Data of 51 patients who underwent EUS from January 2007 to March 2015 due to distal biliary stricture were retrospectively studied. And their diagnosis with EUS, IDUS, bile duct cytological brushing and final diagnosis were compared. Results Malignant bile duct stenosis were finally confirmed in 19 cases and benign stenosis were confirmed in 32 cases. The sensitivity （73.7% VS 57. 1%） and positive predictive value （73.7% VS 57. 1%） of EUS for the benign and malignant diagnosis of biliary tract stenosis were significantly higher than that of IDUS（ P〈0.05 ）, while their specificity（ 84.4% VS 84. 2%）and accuracy（ 80. 4% VS 76. 9%）were similar. The sensitivity of EUS was significantly higher than that of bile duct cytological brushing （ 73.7% VS 50. 0% ） , while their specificity （84.4% VS 100. 0%） and accuracy （ 80.4% VS 81.6%） were similar. EUS findings of hypoechoic mass features had higher diagnostic accuracy for detecting malignant distal bile duct stricture than irregular thickening of the lumen in the distal bile duct （ 100. 0% VS 64. 3%, P〈0.05）. Conclusion For patients with lesions of the distal bile duct that CT/MRI could not diagnose, EUS has an important value for the further diagnosis of benign and malignant bile duct stricture.

关 键 词：腔内超声检查 胆管狭窄 诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575[医药卫生—诊断学]