超声内镜诊断特发性急性胰腺炎的临床价值  

Value of endoscopic ultrasonography in the diagnosis of idiopathic acute pancreatitis

作　　者：张奕秉 姜利佳 朱丽明 朱素芬 ZHANG Yingbing;JIANG Lijia;ZHI Liming;ZHU Sufen(Department of Gastroenterology,The Central Hospital of Wenzhou,Wenzhou 325000, P.R.China)

机构地区：[1]浙江省温州市中心医院消化内科,浙江温州325000

出　　处：《医学影像学杂志》2018年第12期2067-2070,共4页Journal of Medical Imaging

基　　金：浙江省温州市公益性科技计划项目(编号:Y20160293)

摘　　要：目的探讨超声内镜(EUS)诊断特发性急性胰腺炎(IAP)的临床价值。方法收集我院33例特发性急性胰腺炎患者,先行磁共振胰胆管成像(MRCP),再行超声内镜检查确定其病因,并将两者检出病因的构成比作比较,以及评价两种诊断方法。结果特发性急性胰腺炎的病因包含胆管微小结石、胆囊淤泥、慢性胰腺炎、胰腺癌、十二指肠乳头病变、胰腺导管内乳头状黏液瘤以及胰腺分裂。其中1例胰腺癌通过超声内镜引导下细针穿刺活检术,得到病理确诊。EUS对胆囊淤泥、慢性胰腺炎检出病因构成比要明显高于MRCP(P <0. 05);另外EUS和MRCP两种不同诊断方法结果不一致,(Kappa值=0. 085,P> 0. 05); EUS阳性诊断率75. 76%明显高于MRCP的12. 12%(P <0. 05)。结论超声内镜对特发性急性胰腺炎的病因诊断率明显高于MRCP;并可通过超声内镜引导下细针穿刺活检术得到病理诊断。超声内镜可以作为诊断特发性急性胰腺炎的一种有效检查手段。Objective To study the value of endoscopic ultrasonography (EUS) in the diagnosis of idiopathic acute pancreatitis(IAP). Methods 33 patients diagnosed as idiopathic acute pancreatitis in our hospital were accepted Magnetic resonance cholangiopancreatography (MRCP) to detect the causes of diseases before EUS. Besides, causes of diseases detected by MRCP and EUS were compared and these two diagnostic methods were evaluated. Results Idiopathic acute pancreatitis was discovered to result from bile duct microlithiasis, gallbladder sludge, chronic pancreatitis, pancreatic cancer, lesion of duodenum, intraductal papillary mucinous neoplasm (IPMN) and pancreatic divisum. One case of pancreatic malignant tumor was diagnosed by endoscopic ultrasound-guided fine-needle aspiration. The detected constituent ratio of gallbladder sludge and chronic pancreatitis was significantly higher for EUS compared with MRCP (36.36% vs 0%, 15.15% vs 0%, P <0.05). In addition, diagnostic results differed between EUS and MRCP (Kappa coefficient=0.85, P >0.05); the positive rate detected by EUS was as high as 75.76%(25/33), which was much higher than that detected by MRCP, which was 12.12%(4/33),(75.76% vs 12.12% P <0.05). Conclusion Endoscopic ultrasonography may be an effective means of diagnosis of IAP, because its diagnostic rate of IAP is significantly higher than that of MRCP and it can obtain pathological diagnosis by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).

关 键 词：超声内镜 磁共振胰胆管成像 特发性急性胰腺炎 

分 类 号：R445.1[医药卫生—影像医学与核医学] R657.5[医药卫生—诊断学]