超声造影诊断壶腹部良恶性病变的临床价值

The Value of Contrast-Enhanced Ultrasound in the Diagnosis of Benign and Malignant Periampullary Diseases

目的探讨超声造影对壶腹部良恶性病变鉴别诊断的临床价值。方法回顾性分析62例经手术病理组织检查或胆道镜检查证实的壶腹部病变患者,包括壶腹部癌16例、胆总管下段癌11例,十二指肠乳头癌6例,胰头癌5例,胆总管下段结石或胆泥21例,十二指肠乳头炎3例。比较常规超声与超声造影对壶腹部病变的显示能力及良恶性病变的诊断正确性,并分析其超声造影表现。结果超声造影对病变显示率98.4%(61/62)明显优于常规超声54.8%(34/62),其差异有统计学意义(P<0.001);常规超声与超声造影对壶腹部病变诊断的准确性、敏感性、特异性分别为50.0%、55.3%、41.7%与95.2%、97.4%、91.7%,两者比较均有统计学差异(P<0.001)。结论超声造影可提高壶腹部病变的显示能力,且有助于病变的良恶性鉴别诊断,对临床指导治疗具有重要价值。

Objective To evaluate the value of contrast-enhanced ultrasound in the differential diagnosis of benign and malignant periampullary diseases. Methods A total of 62 patients with periampullary diseases confirmed by operating pathology and choledochoscope were reviewed,including 16 cases of periampullary carcinoma,11 cases of common bile duct carcinoma,6 cases of duodenal papilla carcinoma,5 cases of head of pancreas carcinoma,21 cases of bile duct or ampullary stones or biliary sludge and 3 cases of duodunum papillary inflammation. Compared conventional ultrasound and contrast-enhanced ultrasound in the display capacity and the diagnostic accuracy of periampullary diseases,meanwhile,summarized the features of periampullary diseases on contrast-enhanced ultrasound. Results The detection rate of the lesions on contrast-enhanced ultrasound was 98. 4%（ 61 /62）,significantly higher than conventional ultrasound group＇s 54. 8%（ 34 /62）,there was a significant difference（ P〈0. 001）. The accuracy,sensitivity and specificity of the diagnosis of periampullary diseases on conventional ultrasound and contrast-enhanced ultrasound were 50. 0%,55. 3%,41. 7% and95. 2%,97. 4%,91. 7%,respectively. And all of them have had significant difference between the two groups（ P〈0. 001）. Conclusion Contrast-enhanced ultrasound can improve the display capacity of periampullary diseases,which is helpful in differential diagnosis. Moreover,it is valuable for guiding clinical therapy.