不同检查方法诊断中度可疑胆总管结石的对比分析

The comparative analysis of different methods in the diagnosis of suspicious intermediatecholedocholithiasis

目的对比分析超声内镜（EUS）、核磁共振胰胆管造影（MRCP）及内镜下逆行胰胆管造影（ERCP）诊断中度可疑胆总管结石的价值。方法186例临床中度可疑胆总管结石患者均先后接受MRCP、EUS、ERCP检查，以内镜取出结石为金标准，比较不同检查方法的敏感度、特异度和准确度。结果EUS诊断胆总管结石的敏感度为97．5％（155／159），准确度为97．3％（181／186），均显著高于MRCP的92．5％（147／159）和91．9％（171／186），差异有统计学意义（x2=4．21、5．30，P=0．04、0．02）；EUS诊断胆总管结石的特异度为96．3％（26／27），与MRCP[88．9％（24／27）]比较差异无统计学意义（x2=115．40，P〉0．05）。ERCP诊断胆总管结石的准确度、敏感度、特异度分别为98．9％（184／186）、98．7％（157／159）、100．0％（27／27），与EUS比较差异无统计学意义（P〉0．05）。结论EUS诊断胆总管结石的价值与ERCP相似，中度可疑胆总管结石ERCP术前行EUS或MRCP检查可以避免不必要的ERCP。

Objective To compare the effect of endoscopic uhrasonography （EUS）,magnetic resonance chlangiopancreatography （MRCP） and endoscopic retrograde cholangiography （ERCP） in the diagnosis of suspicious intermediate choledocholithiasis. Methods One hundred and eighty-six patientswith suspicious intermediate of choledocholithiasis successively received MRCP,EUS,and ERCP examination. The stone taking out by endoscopic as diagnositic standard, and the sensitivity, specificity and accuracy in different methods was compared. Results Sensitivity and accuracy of EUS was significantly higher than that of MRCP [97.5%（155/159） vs. 92.5%（147/159）,97.3%（181/186） vs. 91.9%（ 171/186）] （X2= 4.21,5.30,P = 0.04,0.02）. There was no statistically significant difference between EUS and ERCP in specificity [ 96.3% （ 26/27 ） vs. 88.9% （ 24/27 ） ] （ X2 = 115.40, P 〈 0.05 ）. Sensitivity, specificity and accuracy of ERCP was 98.9%（184/186） ,98.7%（157/159） and 100.0%（27/27） ,and there was no difference between EUS and ERCP in the diagnosis of choledocholithiasis （P 〉 0.05 ）. Conclusions EUS is similar with ERCP for the diagnosis of choledocholithiasis. By performing EUS or MRCP first, ERCP may be avoided in patients with suspicious intermediate choledocholithiasis.