内镜超声检查对于病因不明的胆总管扩张患者的诊断价值  

Diagnostic value of endoscopic ultrasonography for extra-hepatic bile duct dilation of unknown reasons

作　　者：叶馨[1] 孙波[1] 王坤可 胡冰[1] Ye Xin;Sun Bo;Wang Kunke;Hu Bing(Department of Gastroenterology,Eastern Hepatobiliary Surgery Hospital,Shanghai 200438,China)

机构地区：[1]东方肝胆外科医院内镜科,上海200438

出　　处：《中华消化内镜杂志》2019年第9期671-675,共5页Chinese Journal of Digestive Endoscopy

基　　金：上海市医学领军人才计划(2015-83).

摘　　要：目的临床上有相当一部分肝外胆管扩张的患者未能通过传统影像学检查明确病因。本研究即评估内镜超声检查在诊断此类肝外胆管扩张病变方面的作用。方法回顾性分析2016年2月至2017年9月间的892例内镜超声检查患者的数据。最终诊断依靠内镜和(或)手术病理或随访10个月以上结果。结果共82例肝外胆管扩张(直径≥7 mm)患者纳入本研究,年龄(61.5±9.6)岁,胆总管宽度(13.0±4.25)mm。大部分肝功能异常的患者在EUS检查中发现了可以解释肝外胆管扩张的病因,肝功能正常者中未发现恶性疾病。EUS诊断的总体敏感度、特异度、准确率、阳性预测值、阴性预测值分别为92.7%、100.0%、96.3%、100.0%、93.2%。结论对传统影像学诊断不明的肝外胆管扩张患者,进一步选择EUS明确病因是合理的选择。肝外胆管扩张伴有肝功能异常者需警惕存在恶性疾病。Objective To evaluate diagnostic efficacy of endoscopic ultrasonography ( EUS ) for extra-hepatic bile duct dilation of unknown reasons which failed to be identified by traditional radiological methods. Methods Data of consecutive 892 patients who underwent EUS from February 2016 to September 2017 were retrospectively studied. Final diagnosis was determined by endoscopic retrograde cholangiopancreatography (ERCP)-based biopsy, surgical pathology, or a follow-up of at least 10 months. Results A total of 82 patients with extra-hepatic bile duct dilation (width ≥7 mm) and mean age of 61. 5±9. 6 years were included. The width of common bile duct was 13. 0±4. 25 mm. Reasons for extra-hepatic bile duct dilation could be determined by EUS in most patients with abnormal liver function. No malignant causes were detected in patients with normal liver function. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS were 92. 7%, 100. 0%, 96. 3%, 100. 0%, and 93. 2%, respectively. Conclusion For patients with dilated extra-hepatic bile duct without clear etiology, EUS may be an alternative for determining the etiology of extra-hepatic bile duct dilation. For those with extra-hepatic bile duct dilation with abnormal liver function, malignant causes should not be neglected.

关 键 词：胆总管疾病 胰胆管造影术 内窥镜逆行 腔内超声检查 诊断技术 消化系统 

分 类 号：R575.7[医药卫生—消化系统]