胆管腔内超声对鉴别胆管狭窄性质的临床价值研究

Diagnostic value of intraductal ultrasonography for biliary stricture

目的探讨胆管腔内超声（IDUS）对于判断胆管狭窄性质的临床应用价值。方法收集2006年至2010年因胆管狭窄行胆管腔内超声检查后手术患者，将IDUS结果与手术结果进行对照。结果49例患者中良性狭窄6例，恶性狭窄43例；IDUS判断胆管狭窄性质的敏感度为97．7％（42／43），特异度为83．3％（5／6），阳性预测值为97．7％（42／43），阴性预测值为83．3％（5／6），准确性为95．9％（47／49）；显著高于传统的影像学检查（B超、CT及MRCP）。32例患者曾行胆道刷片检查，其中21例诊断为恶性狭窄，准确率为65．6％。所有胆道刷片诊断为恶性狭窄病例均已经被IDUS所诊断。结论胆管腔内超声可以有效判断胆管狭窄的性质，指导临床治疗。ERCP术中IDUS基础上行胆道刷片对于胆管恶性狭窄诊断价值有限，但是对于明确病理诊断有一定的帮助。

Objective To investigate the diagnostic value of intraductal ultrasonography for the quality of biliary stricture. Methods Data of the patients who had received operation because of biliary stricture after IDUS examination from 2006 to 2010 were collected. IDUS results were compared with those of operation. Results There were 43 cases of malignant strictures and 6 benign strictures in total. The sensi- tivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of intraductal ultrasonography for the quality of biliary stricture were 97.7% （ 42/43 ）, 83.3% （ 5/6 ）, 97.7% （ 42/43 ）, 83.3% （5/6） and 95.9% （47/49）, respectively, which were significantly higher than conventional imaging like ultrasound B, CT and MRCP. Twenty one cases in 32 were diagnosed as malignant biliary stricture with cytological brushing, with the diagnostic aceuracy of 65.6%. All cases had been diagnosed by IDUS. Con- clusion Intraductal ultrasonography is of high diagnostic value for biliary stricture. However, cytological brushing based on IDUS is of limited diagnostic value for malignant biliary stricture.