超声内镜与传统影像学在胆总管扩张病变中的诊断价值比较  

The comparison of diagnostic value of endoscopic ultrasonography and traditional imaging in common bile duct dilatation

作　　者：陶莉[1] 胡祥鹏[1] 谢菁[1] 徐帆 方倩倩[1] 章礼久[1] 刘珺[2] TAO Li;HU Xiang-peng;XIE Jing;XU Fan;FANG Qian-qian;ZHANG Li-jiu;LIU Jun(Department of Gastroenterology,the Second Affiliated Hospital,Anhui Medical University,230601 Hefei,Anhui,China;Department of Basic Medical Sciences,Anhui Medical University,230032 Hefei,Anhui,China)

机构地区：[1]安徽医科大学第二附属医院消化内科,安徽合肥230601 [2]安徽医科大学病理生理教研,安徽合肥230032

出　　处：《临床消化病杂志》2024年第4期256-260,共5页Chinese Journal of Clinical Gastroenterology

基　　金：2021年安徽医科大学校科研基金项目(No:2021xkj052);2021年高校优秀拔尖人才培育资助项目(No:gxgwfx2021012)。

摘　　要：[目的]评价超声内镜(EUS)和传统影像学检查在不明原因胆总管(CBD)扩张病因诊断中的价值。[方法]对78例不明原因CBD扩张患者的实验室检查、传统影像学及EUS结果进行回顾性分析,以活检、穿刺、手术病理及至少12个月的随访结果作为最终诊断。[结果]78例CBD扩张患者中,肿瘤患者(恶性组)与结石及炎性患者(良性组)的性别、发病年龄比较差异无统计学意义。恶性组患者黄疸、体质量下降和胰管扩张多于良性组,而良性组患者腹痛、腹胀更为多见。EUS对CBD扩张病变诊断的灵敏度(97.1%)显著优于经腹超声(US,50%)、CT(70%)和MRI(50%)等常规影像学检查方法。EUS对CBD扩张病变的诊断特异性(86.0%)略优于US(57.1%)和CT(77.1%)。EUS对CBD扩张病变的诊断准确度(91.0%)显著优于US(54.5%)、CT(73.8%)和MRI(74.5%)。EUS对CBD扩张病变的诊断阴性预测值(97.4%)显著优于US(40.0%)、CT(75.0%)和MRI(73.7%)。[结论]EUS在CBD扩张病变中的诊断灵敏度、准确性和阴性预测值显著优于US、CT及MRI等传统影像学检查,特异度略优于US和CT。对传统影像学诊断不明的CBD扩张患者,进一步选用EUS检查明确病因是合理的。[Objective]To evaluate the diagnostic value of endoscopic ultrasonography(EUS)and traditional imaging in unexplained common bile duct(CBD)dilatation.[Methods]Laboratory examination,traditional imaging and EUS results of 78 patients with unexplained CBD dilation were retrospectively analyzed.Biopsy,puncture,surgical pathology and follow-up results of at least 12 months were used as the criteria of final diagnosis.[Results]Among the 78 patients with CBD dilatation,there were no significant differences in gender,and age,between the malignant and benign groups.Jaundice,weight loss and pancreatic duct dilatation were more common in the malignant group than in the benign group,while abdominal pain and bloating were more common in the benign group.The diagnostic sensitivity of CBD dilatation lesions supported that EUS(97.1%)was significantly better than that of transabdominal ultrasound(US)(50.0%),CT(70.0%),MRI(50.0%)and other traditional imaging examination methods.The diagnostic specificity of CBD dilatation lesions supported that EUS(86.0%)was better than US(57.1%)and CT(77.1%).The diagnostic accuracy of CBD dilatation lesions supported that EUS(91.0%)was better than US(54.5%),CT(73.1%),MRI(74.5%).The negative predictive value of the diagnosis of CBD dilatation lesions supported that EUS(97.4%)was better than US(40.0%),CT(75.0%),and MRI(73.7%).[Conclusion]The diagnostic sensitivity,accuracy and negative predictive value of EUS in CBD dilatation lesions are significantly better than those of US,CT and MRI,and the diagnostic specificity of EUS is better than that of US and CT.For patients with unexplained CBD dilatation by traditional imaging,EUS may be an alternative for determining the etiology of CBD dilatation.

关 键 词：胆总管扩张 超声内镜 传统影像学 诊断 

分 类 号：R575.7[医药卫生—消化系统]