慢性胰腺炎的超声内镜表现与诊断

Characteristics and diagnosis of chronic pancreatitis on endoscopic ultrasound

目的探讨超声内镜在慢性胰腺炎(CP)早期诊断中的应用价值。方法对30例CP患者的胰腺超声内镜表现进行分析,并与对照组30例(胃或食道良性小隆起病变)患者的胰腺超声内镜表现进行对照,筛选出超声内镜诊断CP的敏感指标,并行CP超声内镜分型。结果CP组超声内镜表现:(1)胰头增大24例(24/30),与对照组比较差异有非常显著性(P<0.01);(2)假性囊肿6例(6/30),胰石及多发钙化2例,与对照组比较差异无统计学意义(P>0.05);(3)胰腺实质出现腹背分界不清、点状或线状高回声聚集,管壁回声增强分别为22例(22/30)、23例(23/30)、22例(22/30),特异性为70%、46.7%、40%,与对照组比较差异无统计学意义;(4)胰腺背侧腺体回声不均、主胰管大小异常、胰腺边缘细波纹状或模糊、胰腺大小异常、实质异常回声块特异性高均为80%以上,敏感性亦均为50%,与对照组比较差异有统计学意义(P<0.05)。结论CP超声内镜表现具有多样性,包括胰腺大小、实质、胰管、边缘、异常回声块多种声像表现,其中胰腺背侧腺体回声不均,主胰管大小异常,胰腺边缘细波纹状或模糊,胰腺大小异常,实质异常回声块是5个最敏感的指标。

Objective To evaluate the characteristics of the endoscopic ultrasound (EUS) in the diagnosis of chronic pancreatitis(CP), especially in the early stage. Methods Features of CP in 30 cases and 30 healthy volunteers underwent EUS. Results 1.The size of the pancreatic head was larger (24 cases) in CP group than that in the control group with significant difference (P<0.01). 2. There were no differences in pseudocyst, lithes and microcalcification between the 2 groups. 3.The dorsal and ventral demarcation, dot-like and strand-like hyperechoes and the intensive wall echoes were all not significant between the 2 groups (P>0.05). 4. The heterogeneous echoes in the glands of dorsal pancreas, size of pancreatic parenchyma and main ducts, fine wave-like or vagous pancreatic border and abnormal solid echoes were significantly different from those of the control group. The specificity and sensitivity in the CP group was 50% and 80% respectively (P<0.05). Conclusions The heterogeneity in dorsal pancreas, dilated or illegible main ducts, wavy or illegible edges, larger or atrophic size and abnormal echo masses are the 5 criteria for the diagnosis of chronic pancreatitis.