线阵内镜超声对胆总管微结石的诊断价值  

Diagnostic value of endoscopic ultrasonography for common bile duct microlithiasis

作　　者：陈刚[1] 张卫平[1] 鲍峻峻[1] 李杨[1] 梅俏[1] 许建明[1] 洪汝涛[1] Chen Gang;Zhang Weiping;Bao Junjun;Li Yang;Mei Qiao;Xu Jianming;Hong Rutao(Dept of Gastroenterology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)

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：《安徽医科大学学报》2025年第1期147-151,共5页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:81700521);安徽省自然科学基金(编号:2008085QH415)。

摘　　要：目的探讨线阵内镜超声(EUS)对胆总管微结石的诊断价值。方法选取于医院就诊并经EUS诊断为胆总管微结石和胆泥患者资料,从中筛选出住院期间行磁共振胆胰管造影(MRCP)检查和内镜逆行胰胆管造影(ERCP)诊治的患者共85例。以治疗性ERCP/内镜下十二指肠乳头括约肌切开术(EST)结果为金标准。将EUS、MRCP及诊断性ERCP结果(EUS组、MRCP组和诊断性ERCP组)分别与金标准相比较,计算3种检查方法的灵敏度、特异度、阳性预测值、阴性预测值及准确度。结果85例患者中EUS组阳性共63例,假阳性5例;阴性共22例,假阴性1例。MRCP组阳性共49例,假阳性4例;阴性共36例,假阴性14例;诊断性ERCP组阳性共59例,假阳性10例;阴性共26例,假阴性10例。EUS组诊断胆总管微结石的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为98.3%、80.8%、92.1%、95.4%和92.9%;MRCP组为76.3%、84.6%、91.8%、61.1%和78.8%;诊断性ERCP组为83.1%、61.5%、83.1%、61.5%和76.5%。EUS诊断胆总管微结石准确度高于MRCP组(χ^(2)=6.986,P<0.05)和诊断性ERCP组(χ^(2)=8.900,P<0.05)。EUS组、MRCP组和诊断性ERCP组曲线下面积(AUC)值分别为0.895、0.804、0.723,95%CI分别为(0.802~0.988,P<0.001)、(0.702~0.907,P<0.001)和(0.598~0.848,P=0.001)。结论在诊断胆总管微结石方面,EUS具有较高的诊断价值,可作为治疗性ERCP术前首选检查方法。Objective To investigate the diagnostic value of linear array endoscopic ultrasonography(EUS)for common bile duct microlithiasis.Methods Data of patients who attended in the hospital and diagnosed as common bile duct microlithiasis and biliary sludge by EUS were selected.A total of 85 patients with magnetic resonance cholangiopancreatography(MRCP)examination and ERCP treatment during hospitalization were enrolled.The results of endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy(ERCP/EST)were the gold standard for diagnosis.The results of EUS,MRCP,and diagnostic ERCP were compared with the gold standard,and the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of the three methods were calculated,respectively.The chi-square test was used for comparison of the above indices.Results Of all 85 patients,63 had positive EUS results,among whom 5 had false positive results;22 had negative EUS results,among whom 1 had false negative results.Of all 85 patients,49 had positive MRCP results,among whom 4 had false positive results;36 had negative MRCP results,among whom 14 had false negative results.Of all 85 patients,59 had positive diagnostic ERCP results,among whom 10 had false positive results;26 had negative diagnostic ERCP results,among whom 10 had false negative results.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of EUS in diagnosing common bile duct microlithiasis were 98.3%,80.8%,92.1%,95.4%and 92.9%,respectively.For MRCP,these values were 76.3%,84.6%,91.8%,61.1%and 78.8%,respectively.For diagnostic ERCP,these values were 83.1%,61.5%,83.1%,61.5%and 76.5%,respectively.The EUS group had a significantly higher accuracy than the MRCP group(χ^(2)=6.986,P<0.05)and diagnostic ERCP group(χ^(2)=8.900,P<0.05).The areas under the ROC curves(AUC)and 95%CI of EUS group,MRCP group and diagnostic ERCP were 0.895(95%CI:0.802-0.988,P<0.001),0.804(95%CI:0.702-0.907,P<0.001)and 0.723(95%CI:0.598-0.848,P=0

关 键 词：胆总管微结石 胆泥 内镜超声 磁共振胆胰管造影术 内镜逆行胰胆管造影术 诊断 

分 类 号：R575.7[医药卫生—消化系统]