超声内镜联合ALP、GGT在诊断胆总管结石自发排石中的应用研究  

Application of endoscopic ultrasonography combined with ALP and GGT in the diagnosis of spontaneous migration of chole-docholithiasis

作　　者：徐张巍[1] 梅俏[1] 洪江龙 鲍峻峻[1] 陈鹤[1] 许建明[1] XU Zhang-wei;MEI Qiao;HONG Jiang-long(First Affiliated Hospital of Anhui Medical Uniwersity,Depart-ment of Gastroenterology,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院消化内科,合肥230022

出　　处：《肝胆外科杂志》2023年第2期106-110,共5页Journal of Hepatobiliary Surgery

摘　　要：目的探讨超声内镜(EUS)联合血清碱性磷酸酶(ALP)和y谷氨酰转移酶(GGT)在诊断胆总管结石自发排石中的价值。方法回顾性分析安徽医科大学第--附属医院2017年9月~2021年7月收治住院的诊断胆总管结石患者97例,所有患者均通过影像学等检查首诊为胆总管结石,入院拟接受内镜逆行胰胆管造影(ERCP)手术。入院时采集人选者空腹静脉血,测定ALP、GCT水平,并在术前复查此两项指标并行EUS检查。患者经ERCP治疗明确取出结石判定为阳性胆总管结石;EUS诊断为胆总管结石但ERCP未发现结石,EUS检查未发现结石,并且随访期间无胆道症状、复查影像学未发现结石均判定为自发排石。观察患者EUS、ALP和GGT结果,评估EUS、ALP和GGT诊断胆总管结石自发排石的灵敏度和特异度。结果ROC曲线分析显示,ALP和GGT检测诊断胆总管结石的ROC曲线下的面积分别为0.790和0.756,ALP灵敏度和特异度分别为50%和93.3%,GGT为90.38%和62.22%,EUS为96.1%和86.7%。结论ALP、GGT检测可以预测患者可能出现排石,而EUS检查可以较准确判定自发排石,三者联合可以更好的判断胆总管结石自发排石的发生,避免了临床不必要的有创手术,减少了患者的身体创伤及医疗费用。Objective To investigate the diagnostic value of endoscopic ultrasonography(EUS)combining serum alkaline phosphatase(ALP)and gamma glutamyl transferase(GGT)detection in spontaneous migration of choledocholithiasis.Methods Ret-rospective analysis was made on 97 patients with choledocholithiasis diagnosed in the First Affiliated Hospital of Anhui Medical Univer-sity from September 2017 to October 2021.All patients were diagnosed initially as choledocholithiasis through imaging and other exami-nations,and were intended to undergo endoscopic retrograde cholangiopancreatography(ERCP).Fasting venous blood of the selected patients was collected at admission,and the levels of ALP and GGT were measured.These two indicators were rechecked before surger-y and EUS was performed.After ERCP treatment,the patient from whom stones were taken out was definitely diagnosed as positive choledocholithiasis;while through EUS choledocholithiasis was diagnosed,but ERCP did not find any stones,either EUS did not find any stones,and there were no biliary symptoms during the follow-up period,or no stones were found in the recheck imaging,all of which were judged as spontaneous stone migration.The accuracy,sensitivity and specificity of diagnosing spontaneous stone migration through detection of EUS,ALP and GGT were evaluated by observing the results of EUS,ALP and GGT.Results The ROC curve a-nalysis showed that the areas under the ROC curve of ALP and GGT diagnosing choledocholithiasis were 0.790 and 0.756 respectively.The sensitivity and specificity of ALP were 50%and 93.3%,that of CGT was 90.38%and 62.22%,and that of EUS was 96.1%and 86.7%respectively.Conclusion The detection of ALP and GGT can predict the possible occurrence of stone migration,while EUS can accurately determine the occurrence of spontaneous migration of choledocholithiasis.The combination of the three can better determine the occurrence of spontaneous stone migration,so as to avoid unnecessary invasive examination and surgery in clinical prac-tice,reducing the patient's

关 键 词：胆总管结石 自发排石 超声内镜 血清碱性磷酸酶 Y-谷氨酰转移酶 内镜逆行胰胆管造影 R0C曲线 

分 类 号：R657.4[医药卫生—外科学]