胆管腔内超声对胆总管阴性结石的诊断价值

Effect of intraductal ultrasonography in the diagnosis of non-opaque choledocholith

目的评价胆管内超声对胆总管阴性结石的的诊断价值。方法回顾性分析2009年1月-2010年8月上海市第十人民医院消化科临床怀疑胆道结石或狭窄，但根据上腹部CT、磁共振和腹部B超无法确诊，最后行内镜逆行胆胰管造影（ERCP）的患者共183例，男102例，平均年龄69岁，女81例，平均年龄71岁。所有患者先进行ERCP造影，对于胆总管结石阴性患者再行胆管腔内超声（IDUS）探查。结果ERCP诊断胆总管结石阳性134例，占73．2％，阴性49例，占26．8％。49例患者行IDUS探查，其中泥沙样结石24例，低密度结石11例，壶腹部肿瘤6例，胰腺癌2例，硬化性胆管炎6例。IDUS对胆总管结石定位定性准确率为100％，优于ERCP（80％）。ERCP术后3例发生胰腺炎，保守治疗后好转，无穿孔出血等并发症发生。结论腔内超声技术对胆总管阴性结石的定位定性准确率高，可弥补ERCP的误诊漏诊，不增加ERCP的并发症。可以为l临床上胆总管结石诊断提供可靠依据。

Objective To evaluate the diagnostic value of intraductal ulstrasonography （IDUS） in non-opaque bile duct stones. Methods Between January 2009 and August 2010 in the Department of Gastroenterology at Shanghai 10th People＇s Hospital, a total of 183 patients （male： 102 cases, mean age 69 years; female： 81 cases, mean age 71 years） were enrolled, who were suspected of bile duct stones or stenosis which could not be diagnosed by abdominal CT, MRI, and abdominal B-mode ultrasound. All the patients underwent endoscopic retrograde cholangiopancreatography （ERCP） first, and then patients with non-opaque bile duct stones followed by IDUS. Results A total of 134 cases （73.2%） of bile duct stones were diagnosed by ERCP, 49 cases （26.8%） were negative. And then the 49 patients underwent IDUS, of whom 24 patients with sand-like stones, 11 patients with low- density stones, 6 patients with ampullary cancer, 2 patients with pancreatic cancer, 6 patients with sclerosing cholangitis. The diagnostic accuracy of IDUS in the position and quality of bile duct stones was 100%, higher than that of ERCP, which was 80%. After ERCP, pancreatitis occurred in 3 patients and improved after conservative treatment, there was no complications like perforation and bleeding. Conclusion The diagnostic accuracy of IDUS in the position and quality of bile duct stones is high, which can make up for the misdiagnosis by ERCP without inereasing the complications. IDUS can provide reliable basis for the diagnosis of clinical bile duct stones.