超声内镜与磁共振胰胆管成像对胆总管泥沙样结石的诊断价值  

Diagnostic value of endoscopic ultrasound and magnetic resonance cholangiopancreatography for common bile duct sludge-like stones

作　　者：许灿[1] 周鹏哲 朱宁[3] 穆维娜[4] Xu Can;Zhou Pengzhe;Zhu Ning;Mu Weina(Department of Medical,The First Central Hospital of Baoding,Baoding 071000,China;Department of Gastroenterology,The First Central Hospital of Baoding,Baoding 071000,China;Department of Cardiology,The First Central Hospital of Baoding,Baoding 071000,China;Department of Ultrasound,The First Central Hospital of Baoding,Baoding 071000,China)

机构地区：[1]保定市第一中心医院医务处,河北省071000 [2]保定市第一中心医院消化科,河北省071000 [3]保定市第一中心医院心内科,河北省071000 [4]保定市第一中心医院超声科,河北省071000

出　　处：《中华消化病与影像杂志（电子版）》2023年第5期359-362,共4页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的 本研究旨在探讨超声内镜(EUS)与磁共振胰胆管成像(MRCP)在胆总管泥沙样结石诊断中的价值。方法 回顾性分析2020年4月至2023年4月于保定市第一中心医院住院治疗的疑似胆总管泥沙样结石患者192例,经纳入与排除标准筛选,最终纳入182例患者作为研究对象。所有患者首先进行MRCP检查,若MRCP结果提示泥沙样结石则直接行内窥镜逆行胰胆管造影(ERCP)检查,其余患者依次行EUS和ERCP。以ERCP造影联合乳头括约肌切开取石(EST)作为诊断胆总管泥沙样结石的金标准,将各项检查结果与取石结果进行比较。结果 EUS、MRCP和EUS联合MRCP检出胆总管泥沙样结石的阳性率分别为81.76%、65.38%和86.49%;在经ERCP下EST所证实的阳性结果中,EUS检出胆总管泥沙样结石的敏感度、特异度和准确度分别为93.08%、83.33%和91.89%;MRCP为72.56%、77.78%和73.08%;EUS联合MRCP为98.46%、88.89%和97.30%。结论 EUS和MRCP在胆总管泥沙样结石的诊断中都具有一定潜力,但EUS在准确性方面更具优势。EUS联合MRCP可能是提高胆总管泥沙样结石诊断准确率的有效策略。Objective To explore the value of endoscopic ultrasound(EUS)and magnetic resonance cholangiopancreatography(MRCP)in the diagnosis of common bile duct sludge-like stones.Methods A retrospective analysis was conducted on 192 patients with suspected sludge-like choledocholithiasis who were hospitalized in the First Central Hospital of Baoding from April 2020 to April 2023.After applying the inclusion and exclusion criteria,182 patients were ultimately selected for the study.All patients first underwent MRCP examination.If MRCP results indicated sludge-like stones,they immediately underwent endoscopic retrograde cholangiopancreatography(ERCP).The remaining patients sequentially underwent EUS and then ERCP.ERCP radiography combined with endoscopic sphincterotomy(EST)for stone extraction was considered the gold standard for diagnosing sludge-like choledocholithiasis,and the results from various examinations were compared with the stone extraction results.Results The positive detection rates of EUS,MRCP,and the combination of EUS and MRCP for sludge-like choledocholithiasis were 81.76%,65.38%,and 86.49%,respectively.Among the positive results confirmed by ERCP with EST,the sensitivity,specificity,and accuracy of EUS in detecting sludge-like choledocholithiasis were 93.08%,83.33%,and 91.89%,respectively.For MRCP,these values were 72.56%,77.78%,and 73.08%.For the combination of EUS and MRCP,the values were 98.46%,88.89%,and 97.30%.Conclusion Both EUS and MRCP show potential in diagnosing sludge-like choledocholithiasis,with EUS displaying a superior accuracy advantage.Combining EUS with MRCP may be an effective strategy to enhance the diagnostic accuracy of common bile duct sludge-like stones.

关 键 词：超声内镜 磁共振胰胆管成像 胆总管泥沙样结石 内镜逆行胰胆管造影 诊断 

分 类 号：R575.62[医药卫生—消化系统] R445[医药卫生—内科学]