内镜超声在拟行经内镜逆行性胰胆管造影术前诊断可疑胆胰疾病临床价值

Clinical application of EUS combined with ERCP in suspected pancreatobiliary diseases

目的 探讨超声内镜（EUS）诊断可疑胆胰病变的临床诊疗价值。方法 选择2010年1月至2013年12月在重庆医科大学附属成都市第三人民医院住院26例可疑胆胰疾病患者，其中男性14例，女性12例；年龄27 ～ 81岁，中位年龄63岁。不能完全确诊拟行经内镜逆行性胰胆管造影术（ERCP）检查，先行EUS检查；24例再行ERCP，2例患者随访。结果 26例患者确诊胆总管结石并行取石术14例，胆管癌2例，壶腹部肿瘤2例，胰头癌1例，导管内乳头状黏液瘤（IPMN）2例，十二指肠乳头炎性狭窄1例，胰管结石2例；EUS检查未发现明确异常2例随访。其中有3例行超声内镜引导下细针穿刺术（EUS-FNA）获得组织学证据。结论 先行EUS，对可疑胆胰疾病有很高的诊疗价值。ERCP前进行EUS检查对于指导ERCP下的治疗有重要意义，并可以避免不必要的ERCP。

Objective To evaluate the clinical value of endoscopic ultrasonography（EUS） before endoscopic retragrade cholangiopancreatography（ERCP） in patients with undiagnosed pancreatobiliary diseases. Methods From January 2010 to December 2013, 26 patients were enrolled（male 14, female 12, aged 27- 81 years old with median age of 63 years old）, who suffered from undiagnosed pancreatobiliary diseases underwent EUS before ERCP management. EUS findings suggested that 24 of 26 cases received ERCP and the other 2 be followed up. Results There were 14 cases of choledocholithiasis, 2 of cholangiocarcinoma, 2 of periampullary carcinoma, 1 of pancreatic head carcinoma, 2 of IPMN, 1 of major papillary inflammatory stricture and 2 of pancreatic stones. Two cases were normal and followed up. Histopathological results were obtained via EUS-FNA in 3 cases. Conclusion EUS has significant diagnostic value for undiagnosed pancreatobiliary diseases. EUS guided ERCP management is proved to be important and avoid unnecessary ERCP intervention.