超声内镜对胆总管结石的诊断价值

崔喻芳; 鲍峻峻; 宋育林; 张磊; 梅俏

doi:10.3969/j.issn.1001-5256.2019.12.020

超声内镜对胆总管结石的诊断价值

DOI: 10.3969/j.issn.1001-5256.2019.12.020

安徽医科大学第一附属医院消化内科

基金项目:

安徽省教育厅高等学校省级质量工程教学研究项目课题(2015jyxm770)；

详细信息

中图分类号: R575.62;R445.1
计量
- 文章访问数: 1386
- HTML全文浏览量: 53
- PDF下载量: 230
- 被引次数: 4
出版历程
- 收稿日期: 2019-07-08
- 出版日期: 2019-12-20

Clinical effect of endoscopic ultrasonography in the diagnosis and evaluation of common bile duct stones

Department of Gastroenterology,The First Affiliated Hospital of Anhui Medical University

Research funding:

摘要

摘要: 目的探讨超声内镜（EUS）对胆总管结石的诊断价值。方法选取2017年6月-2019月4月就诊于安徽医科大学第一附属医院并疑诊胆总管结石患者98例。患者在院期间行EUS及磁共振胰胆管造影（MRCP）检查。以开腹探查/腹腔镜胆总管探查及经内镜逆行胰胆管造影/内镜下十二指肠乳头括约肌切开术结果为金标准。将EUS、MRCP及二者联合诊断（以EUS与MRCP任一阳性则为阳性,二者均阴性则为阴性）结果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、阴性预测值及诊断准确度。以上指标差别比较采用χ2检验。结果 98例患者中EUS组阳性共92例,假阳性5例;阴性共6例,假阴性3例。MRCP组阳性69例,假阳性2例;阴性29例,假阴性23例。联合组阳性94例,假阳性5例;阴性4例,假阴性1例。EUS组灵敏度明显高于MRCP组（96. 67%vs 74. 44%,χ2=17. 982,P <0. 05）; EUS组与联合组灵敏度差异无统计学意义（96. 67%vs 98. 89%,χ2=1. 023,P=0. 312）。微小结石（≤0. 5cm）疑诊患者共52例,EUS组阳性51例,...
- 胆总管结石病 /
- 腔内超声检查 /
- 胰胆管造影术,磁共振 /
- 诊断
Abstract: Objective To investigate the value of endoscopic ultrasonography( EUS) in the diagnosis of common bile duct stones. Methods A total of 98 patients who attended The First Affiliated Hospital of Anhui Medical University from June 2017 to May 2019 and were suspected of common bile duct stones were enrolled. All patients underwent EUS and magnetic resonance cholangiopancreatography( MRCP) during hospitalization. The results of open/laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy were the gold standard for diagnosis. The results of EUS alone,MRCP alone,and EUS combined with MRCP( positive results of EUS or MRCP were considered positive,and negative results of both EUS and MRCP were considered negative) 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. The chi-square test was used for comparison of the above indices. Results Of all 98 patients,92 had positive EUS results,among whom 5 had false positive results; 6 had negative EUS results,among whom 3 had false negative results. Of all 98 patients,69 had positive MRCP results,among whom 2 had false positive results; 29 had negative MRCP results,among whom 23 had false negative results. Of all 98 patients,94 had positive MRCP/EUS results,among whom 5 had false positive results; 4 had negative MRCP/EUS results,among whom 1 had false negative results. The EUS group had a significantly higher sensitivity than the MRCP group( 96. 67%vs 74. 44%,χ2= 17. 982,P < 0. 05),while there was no significant difference in sensitivity between the EUS group and the combined group( 96. 67% vs 98. 89%,χ2= 1. 023,P = 0. 312). There were 52 patients who were suspected of biliary microlithiasis( ≤0. 5 cm),among whom 51 had positive EUS results,including 3 patients with false positive results; 1 had false negative EUS results; among these 52 patients,36 had positive MRCP results,including 1 patient with false positive results; 16 had negative MRCP results,including 14 patients with false negative results; all 52 patients had positive results of EUS combined with MRCP,among whom 3 had false positive results. The EUS group had a significantly higher diagnostic sensitivity than the MRCP group( 97. 96% vs 71. 43%,χ2= 13. 303,P < 0. 05),while there was no significant difference between the EUS group and the combined group( 97. 96% vs 100%,P = 1. 0). Conclusion EUS has great advantages in the diagnosis of common bile duct stones,especially biliary microlithiasis. EUS has a high diagnostic value and can thus be used as the preferred examination before invasive operation.
- choledocholithiasis /
- endosonography /
- cholangiopancreatography,magnetic resonance /
- diagnosis

HTML全文

参考文献(12)

[1] LU YP,YE JS,YAO L. Descending intraoperative nasobiliary drainage plus primary closure of the commom bile duct after laparascopic CBD stone clearance[J]. Chin J Gen Surg,2016,31(11):893-896.(in Chinese)路夷平，叶晋生，姚力．腹腔镜胆总管探查顺行鼻胆管引流胆总管一期缝合的临床应用[J]．中华普通外科杂志，2016,31(11):893-896.

[2] COLLINS C,MAGUIRE D,IRELAND A,et al. A prospective study of CBD calculi in patients undergoing laparoscopic cholecystectomy:Natural history of choledocholithiasis revisited[J]. Ann Surg,2004,239(1):28-33.

[3] DENG XM,YANG X,CHEN Y,et al. Minimally invasive therapy for occult choledocholithiasis during laparoscopic cholecystectomy[J]. Chin J Min Inv Surg,2014,14(9):796-798.(in Chinese)邓小明，杨星，陈焱，等．腹腔镜胆囊切除术中隐匿性胆总管结石的微创治疗[J]．中国微创外科杂志，2014,14(9):796-798.

[4] WANG C,XU F,DAI CL. Value of endoscopic ultrasonography combined with magnetic resonance cholangiopancreatography in diagnosis of patients suspected of common bile duct stones[J]. J Clin Hepatol,2019,35(1):128-131.(in Chinese)王超，徐锋，戴朝六．超声内镜联合磁共振胰胆管造影对可疑胆总管结石的诊断价值[J]．临床肝胆病杂志，2019,35(1):128-131.

[5] GURUSAMY KS,GILJACA V,TAKWOINGI Y,et al. Ultrasound versus liver function tests for diagnosis of common bile duct stones[J]. Cochrane Database Syst Rev,2015,2:CD011548.

[6] Chinese Research Hospital Association,Society for Hepatopancreato-biliary Surgery; Expert Committee of PublicWelfare Scientific Research Program of National Heahh Commission.Guidelines for minimally invasive surgery for hepatolithiasis(2019 edition)[J]. Chin J Dig Surg,2019,18(5):407-413.(in Chinese)中国研究型医院学会肝胆胰外科专业委员会，国家卫生健康委员会公益性行业科研专项专家委员会．肝胆管结石病微创手术治疗指南(2019版)[J]．中华消化外科杂志，2019,18(5):407-413.

[7] ALMADI MA,BARKUN JS,BARKUN AN. Management of suspected stones in the common bile duct[J]. CMAJ,2012,184(8):884-892.

[8] LIN LF,HUANG PT. Linear endoscopic ultrasound for clinically suspected bile duct stones[J]. J Chin Med Assoc,2012,75(6):251-254.

[9] GILJACA V,GURUSAMY KS,TAKWOINGI Y,et al. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography for common bile duct stones[J]. Cochrane Database Syst Rev,2015,2:CD011549.

[10] KONDO S,ISAYAMA H,AKAHANE M,et al. Detection of common bile duct stones:Comparison between endoscopic ultrasonography,magnetic resonance cholangiography,and helical-computed—tomographic cholangiography[J]. Eur J Radiol,2005,54(2):271-275.

[11] YAGHOOBO M,MEERALAM Y,AL-SHAMMARI K. Diagnostic accuracy of EUS compared with MRCP in detecting choledocholithiasis:A meta-analysis of diagnostic test accuracy in head-to-head studies[J]. Gastrointest Endosc,2017,86(6):986-993.

[12] MAPLE JT,BEN-MENACHEM T,ANDERSON MA,et al. The role of endoscopy in the evaluation of suspected choledocholithiasis[J]. Gastrointest Endosc,2010,71(1):1-9.

施引文献

期刊类型引用(2)

1.	马宏涛，李璐辰，刘汝杰，李润东，王磊. 水飞蓟宾联合阿昔莫司口服治疗非酒精性脂肪性肝炎的疗效及安全性观察. 山东医药. 2024(14): 49-52 . 百度学术
2.	肖炜，王欣鑫，张坪，周斌，唐奇志，李世香. 从病因病机共性探讨2型糖尿病、非酒精性脂肪性肝病与高尿酸血症内在联系. 中国中医药图书情报杂志. 2024(06): 13-17 . 百度学术