胆管内超声对胆管结石诊断价值的研究

Intraductal ultrasonography in diagnosis of bile duct stones

目的 通过对磁共振胰胆管成像（MRCP）、内镜下逆行胆管造影（ERC）和十二指肠镜下胆管腔内超声（IDUS）对肝外胆管结石诊断作用的比较,评价IDUS对胆管结石的诊断价值.方法 对30例临床怀疑肝外胆管结石的患者,先行MRCP,然后行ERC,同时用经导丝的腔内超声探头行胆管内扫查.IDUS检查完成后,行内镜下取石,证实诊断.结果 30例中,MRCP准确诊断结石22例,将胆管絮状物诊断为结石2例,漏诊2例,其诊断结石的准确性、敏感性、特异性分别为86.7%（26/30）、91.7%（22/24）、66.7%（4/6）;ERC准确诊断结石23例,将胆管积气诊断为结石2例,漏诊1例,其诊断结石的准确性、敏感性、特异性分别为90%（27/30）、92%（23/25）、66.7%（4/6）;IDUS准确诊断结石24例,絮状物4例,气泡2例,无漏诊及误诊,其诊断结石的准确率、敏感性、特异性均为100%.结论 IDUS是一项安全可靠的技术,在确定胆管结石方面优于ERCP和MRCP.

Objective To investigate the diagnostic value of intraductal ultrasonography （IDUS） for bile duct stones by comparing between magnetic resonance cholangiopancreatography （ MRCP）, endoscopic retrograde cholangiography （ERC） and IDUS. Methods ERC was performed in 30 patients with suspected extrahepatic cholelithiotic after MRCP. IDUS was applied through guide wire after ERC, and stones were removed if necessary. Results MRCP detected bile duct stones in 22 cases, misdiagnosed bile duct floc as stones in 2 and missed stones in 2 others. The accuracy, sensitivity and specificity of MRCP in diagnosis of bile duct stone were 86. 7% （26/30）, 91. 7% （22/24）, and 66. 7% （4/6）, respectively. ERC detected bile duct stones in 23 cases, misdiagnosed bile duct air bubble as stones in 2 and missed stones in 1. The accuracy , sensitivity and specificity of MRCP in diagnosis of bile duct stone were 90% （27/30）, 92% （23/25） and 66.7% （4/6） , respectively. IDUS detected 24 cases of bile duct stones, 4 bile duct floc and 2 air bubble without any misdiagnosis. The accuracy, sensitivity and specificity of IDUS in diagnosis of bile duct stone were 100%. Conclusion IDUS, safe and reliable, is superior to ERC and MRCP in diagnosis of bile duct stone.