超声内镜在胆总管扩张病因鉴别诊断中的价值  

The value of endoscopic ultrasound in the differential diagnosis of the etiology of common bile duct dilatation

作　　者：王婷[1] 董蕾[1] 马师洋[1] 赵刚[1] 秦斌[1] 薛琼 史海涛[1] WANG Ting;DONG Lei;MA Shiyang;ZHAO Gang;QIN Bin;XUE Qiong;SHI Haitao(Department of Gastroenterology,the Second Affiliated Hospital of Xi'an Jiaotong University,Key Laboratory of Gastrointestinal Power Diseases,the Center for Clinical Research of Gastrointestinal Diseases,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院消化内科,陕西省胃肠动力疾病重点实验室,陕西省胃肠疾病临床研究中心,陕西西安710004

出　　处：《胃肠病学和肝病学杂志》2024年第11期1525-1529,共5页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探究超声内镜(endoscopic ultrasound,EUS)在鉴别诊断胆总管扩张病因中的价值。方法选取2019年6月至2022年12月在西安交通大学第二附属医院行EUS检查诊断胆总管扩张者。统计分析纳入患者的一般人口特征资料、既往常规影像学检查结果、肿瘤标志物、肝功能等。最终以ERCP或手术活检病理或至少随访3个月以上结果未改变为诊断金标准。结果共纳入241例患者,通过金标准诊断为非肿瘤性病变者126例,肿瘤性胆总管扩张病因者115例。与金标准诊断相比,EUS对肿瘤性胆总管扩张病因总体诊断的灵敏度79.1%,特异度95.2%,阳性预测值93.8%,阴性预测值83.3%,其准确率为87.6%,高于彩超、平扫CT、增强CT及MRCP,差异有统计学意义(P<0.05)。EUS联合肿瘤标志物联合报警症状的诊断准确性高达97.9%,高于单独EUS检查、EUS联合肿瘤标志物、EUS联合报警症状组,差异有统计学意义(P<0.05)。结论EUS对于肿瘤性与非肿瘤性胆总管扩张病因的鉴别诊断有着较高的临床价值,EUS联合肿瘤标志物和报警症状有助于提高EUS对于肿瘤性胆总管扩张病因的鉴别诊断,避免漏诊误诊肿瘤性病变。Objective To explore the value of endoscopic ultrasound(EUS)in the differential diagnosis of the etiology of common bile duct dilatation.Methods The patients were diagnosed as common bile duct expansion by EUS examination which was performed in the Second Affiliated Hospital of Xi'an Jiaotong University to from Jun.2019 and Dec.2022.The general demographic characteristics,previous conventional imaging results,tumor markers,liver function,etc were analysed.The final pathology of ERCP or surgical biopsy or follow-up for at least 3 months.Results A total of 241 patients were included,including 126 patients diagnosed with non-neoplastic lesions by the gold standard and 115 patients with causes of neoplastic choledochal dilatation.Compared with the gold standard diagnosis,the sensitivity of EUS for the overall diagnosis of neoplastic common bile duct dilation was 79.1%,specificity was 95.2%,positive predictive value were 93.8% and 83.3%.The accuracy(87.6%)was higher than that of color ultrasound,plain CT,enhanced CT and MRCP,which was statistically significant.The diagnostic accuracy of EUS combined with tumor markers and alarm symptoms was as high as 97.9%,which was higher than that of EUS examination alone,EUS combined with tumor markers and EUS combined with alarm symptoms group,which showed statistical difference.Conclusion EUS has high clinical value in the differential diagnosis of neoplastic and non-neoplastic common bile duct dilation.The combination of EUS with tumor markers and alarm symptoms helps to improve the differential diagnosis of EUS for the etiology of neoplastic choledochal dilatation and avoid missed misdiagnosis of neoplastic lesions.

关 键 词：超声内镜 胆总管扩张 肿瘤性病变 鉴别诊断 

分 类 号：R575.7[医药卫生—消化系统]