经鼻胆管引流管注水超声检查:一种检测内镜下胆管取石术后残留结石的新方法  

Trans-nasal biliary drainage tube water-injection ultrasound: a new method for detecting residual stones after endoscopic extraction of bile duct stones

作　　者：吴晓东 唐少珊[2] 吴硕东[1] Wu Xiaodong;Tang Shaoshan;Wu Shuodong(The Second Department of General Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Ultrasound,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院第二普通外科,沈阳110004 [2]中国医科大学附属盛京医院超声科,沈阳110004

出　　处：《中华消化杂志》2024年第1期44-49,共6页Chinese Journal of Digestion

摘　　要：目的观察经内镜鼻胆管引流管注射0.9%氯化钠溶液后的腹部超声检查(以下简称注水超声)对内镜逆行胰胆管造影(ERCP)取石后胆管残余结石的检出能力。方法纳入2015年1月至2023年6月在中国医科大学附属盛京医院第二普通外科诊断为胆总管结石并经ERCP取石同时留置内镜鼻胆管引流管的342例患者, 所有患者在接受ERCP取石术后, 分别行胆道造影、常规腹部超声和注水超声检查。以二次取石手术取出结石为真阳性, 比较胆道造影、常规腹部超声和注水超声检查对胆管残余结石的检出能力。统计学方法采用卡方检验。结果胆道造影检查结果提示35例患者怀疑存在胆管残留结石, 其中28例被证实为真阳性, 灵敏度为50.9%, 特异度为97.6%;常规腹部超声结果提示15例患者怀疑存在胆管残留结石, 其中13例被证实为真阳性, 灵敏度为23.6%, 特异度为99.3%;注水超声结果提示56例患者怀疑存在胆道残留结石, 其中50例被证实为真阳性, 灵敏度为90.9%, 特异度为97.9%。注水超声检查的真阳性患者数分别多于胆道造影和常规腹部超声检查, 灵敏度分别高于胆道造影和常规腹部超声检查, 差异有统计学意义(χ^(2)=21.33、50.85、38.77、92.53, 均P<0.001);注水超声检查的特异度与胆道造影和常规腹部超声检查比较差异均无统计学意义(均P>0.05)。结论注水超声检查可有效提升ERCP后残余胆管结石的检出率。Objective To observe the ability of abdominal ultrasonography(hereinafter referred to as water-injection ultrasonography)after injection of 0.9%sodium chloride solution via endoscopic nasobiliary drainage tube in the detection of residual stones in bile duct after stone extraction by endoscopic retrograde cholangiopancreatography(ERCP).Methods From January 2015 to June 2023,at the Second Department of General Surgery,Shengjing Hospital,China Medical University,342 patients,who were diagnosed with choledochal stones and received stone extraction by ERCP and at the same time placed endoscopic nasobiliary drainage tube,were enrolled.After stone extraction by ERCP,all the patients underwent cholangiography,conventional abdominal ultrasound,and water-injection ultrasonography.The patients with stones removed by the secondary ERCP were positive.The ability to detect residual stones in bile duct by cholangiography,conventional abdominal ultrasound and water-injection ultrasonography were compared.Chi-square test was performed for statistical analysis.Results The results of cholangiography showed that 35 patients were suspected with residual stones in bile duct,among them 28 were confirmed to be true-positive,the sensitivity was 50.9%and specificity was 97.6%;the results of conventional abdominal ultrasound showed that 15 patients were suspected with residual stones in bile duct,among them 13 were confirmed to be true positive with a sensitivity of 23.6%and a specificity of 99.3%;and the results of water-injection ultrasonography showed that 56 patients were suspected with residual stones in bile duct,among them 50 were confirmed as true positive,with a sensitivity of 90.9%and a specificity of 97.9%.The number of true-positive patients detected by water-injection ultrasonography was greater than those determined by cholangiography and conventional abdominal ultrasonography,and the sensitivity was higher than that of cholangiography and conventional abdominal ultrasonography,and the differences were statistically signific

关 键 词：ERCP术后残余结石 内镜鼻胆管引流管 腹部超声 

分 类 号：R657.42[医药卫生—外科学]