超声内镜对胰胆管扩张病因的诊断价值

Endoscopic ultrasonography in diagnosis of causes for biliary-pancreatic duct dilatation

目的 探讨超声内镜对胰胆管扩张病因的诊断价值。 方法 对 2 5例体外超声 (US)检查发现有肝外胆管胰管扩张 ,但病因诊断有困难的患者施行超声内镜 (EUS)、CT、MRI检查 ,并比较各种检查法的诊断效能。病种包括壶腹周围肿瘤 19例 ,胆总管下段嵌顿性结石 3例和其他病变 3例。 结果 与手术后病理对比 ,US、EUS、CT、MRI的病变检出率依次为 17 4% (4 / 2 3)、82 6 % (19/2 3)、2 1 7% (5 / 2 3)和 2 6 7% (4 / 15 ) ,对 19例肿瘤的检出率分别为 10 5 % (2 / 19)、84 2 % (16 / 19)、15 7%(3/ 19)、2 3 1% (3/ 13) ,EUS对肿瘤定位的符合率为 87 5 % (14/ 16 )。与其他影像学检查相比 ,肿瘤越小EUS的优势越大。对 3例结石US均未能确诊 ,EUS 3例全部检出并确诊 ,CT检出 2例 ,MRI在 2例中检出 1例。 结论 EUS是诊断胰胆管扩张病因、鉴别病变性质、确定肿瘤起源的敏感检查方法 ,但对小于

Objective To investigate the value of endoscopic ultrasonography (EUS) in the diagnosis of causes for cholangiopancreatic duct dilatation (CPDD). [WT5”HZ]Methods[WT5”BZ] Twenty five patients with CPDD without visual lesions or with unconfirmed lesions in traditional ultrasonography (US) were re examined by EUS, CT and MRI. Of the 25 patients, 19 had periampullary tumor , 3 incarcerated stone at the lower fragment of the common bile duct and 3 obstruction for other causes. [WT5”HZ]Results[WT5”BZ] As compared with the results of postoperative pathological examination, the detection rate of obstructive lesions by US, EUS, CT and MRI was 17 4% (4/23), 82 6% (19/23), 21 7% (5/23) and 26 7% (4/15), respectively. Their detection rate of tumors was 10 5% (2/19), 84 2% (16/19), 15 7% (3/19) and 23 1% (3/13), respectively. The accuracy of tumor localization by EUS was 87 5%. None of the patients with incarcerated stone were confirmed by US. However, all the patients were confirmed by EUS except, 2 by CT and 1 by MRI. [WT5”HZ]Conclusions[WT5”BZ] EUS is much more sensitive in detecting obstructive lesions and accurate in determining tumor location than US, CT and MRI. However, it is still difficult for EUS to diagnose the papillary tumor or common bile duct tumor with a diameter less than 1 cm.