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Endoscopic ultrasound features of distal biliary stricture
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摘要:
目的 回顾性分析胆总管远端狭窄患者的超声内镜(EUS)特征，为EUS评估胆总管远端狭窄提供临床依据。 方法 收集安徽医科大学第一附属医院2016年4月—2020年3月行EUS检查的175例胆总管远端狭窄的患者临床资料，分析患者的临床表现、实验室、影像学及EUS检查结果，并进行随访，总结胆总管远端狭窄的EUS特征。计数资料两组间比较采用χ2检验，计量资料两组间比较采用t检验。 结果 175例胆总管远端狭窄患者中，良性胆总管远端狭窄85例(85/175，48.57%)，恶性胆总管远端狭窄90例(90/175，51.43%)。在恶性胆总管远端狭窄的患者中，EUS显示狭窄长度高于良性胆总管远端狭窄患者[(14.1±3.0) mm vs (7.9±3.0) mm, t=13.358，P＜0.001]，同时EUS发现恶性胆总管远端狭窄患者的管腔低回声占位(57.8% vs 34.1%, χ2=9.843，P=0.002)、周围淋巴结肿大(26.7% vs 12.9%, χ2=5.147，P=0.023)及胰管扩张(51.1% vs 28.2%, χ2=9.532，P=0.002)等特征性改变发生率高于良性胆总管远端狭窄患者。EUS和MRCP两者联合诊断良性胆总管远端狭窄的敏感性为70.6%，诊断恶性胆总管远端狭窄的敏感性为92.2%。 结论 胆总管远端狭窄具有如较长狭窄、低回声、周围淋巴结肿大及胰管扩张等EUS图像特征，有助于临床中胆总管远端狭窄的鉴别诊断作用。 Abstract:Objective To investigate the endoscopic ultrasound (EUS) features of distal biliary stricture (DBS), and to provide a clinical basis for the evaluation of DBS by EUS. Methods Related clinical data were collected from 175 patients with DBS who underwent EUS examination in The First Affiliated Hospital of Anhui Medical University from April 2016 to March 2020 to analyze their clinical manifestation, laboratory examination results, imaging findings, and EUS findings, and the patients were followed up to summarize the EUS features of DBS. The chi-square test was used for comparison of categorical data between groups, and the t-test was used for comparison of continuous data between groups. Results Among the 175 patients with DBS, 85(48.57%) had benign DBS and 90(51.43%) had malignant DBS. Compared with the patients with benign DBS, the patients with malignant DBS had a significantly longer length of stricture on EUS (14.1±3.0 mm vs 7.9±3.0 mm, t=13.358, P < 0.001) and significantly higher incidence rates of the characteristic changes on EUS such as hypoechoic space-occupying lesions in lumen (57.8% vs 34.1%, χ2=9.843, P=0.002), peripheral lymph node enlargement (26.7% vs 12.9%, χ2=5.147, P=0.023), and pancreatic duct dilatation (51.1% vs 28.2%, χ2=9.532, P=0.002). EUS combined with magnetic resonance cholangiopancreatography had a sensitivity of 70.6% in the diagnosis of benign DBS and a sensitivity of 92.2% in the diagnosis of malignant DBS. Conclusion The characteristic EUS features of DBS, such as long length of stricture, hypoechoic lesion, peripheral lymph node enlargement, and pancreatic duct dilatation, may help with the differential diagnosis of DBS in clinical practice. -
表 1 胆总管远端狭窄的EUS特征分析
EUS特征 良性胆总管远端狭窄(n=85) 恶性胆总管远端狭窄(n=90) 统计值 P值 狭窄段长度(mm) 7.9±3.0 14.1±3.0 t=13.358 ＜0.001 不规则不均匀增厚[例(%)] 15(17.6) 25(27.8) χ2=2.544 0.111 管腔低回声占位[例(%)] 29(34.1) 52(57.8) χ2=9.843 0.002 周围淋巴结肿大[例(%)] 11(12.9) 24(26.7) χ2=5.147 0.023 胰管扩张[例(%)] 24(28.2) 46(51.1) χ2=9.532 0.002 十二指肠乳头占位[例(%)] 13(15.3) 18(20.0) χ2=0.664 0.415 壶腹部占位[例(%)] 16(18.8) 19(21.1) χ2=0.143 0.705 
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表 2 EUS、MRCP对胆总管远端狭窄的诊断效能
疾病分类 诊断方法 敏感度(%) 特异度(%) 阳性预测值(%) 阴性预测值(%) 良性胆总管远端狭窄 EUS 52.9 80.0 71.4 64.3 MRCP 34.1 81.1 63.0 56.6 两者联合 70.6 65.6 66.7 70.2 恶性胆总管远端狭窄 EUS 72.2 74.1 74.7 71.6 MRCP 60.0 95.3 93.1 69.2 两者联合 92.2 71.8 77.6 89.7
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