双重超声造影对梗阻性黄疸诊断价值的评估

Diagnostic value of double contrast-enhanced ultrasound in obstructive jaundice

目的探讨双重超声造影技术对梗阻性黄疸的诊断价值。方法对79例梗阻性黄疸患者进行超声引导下经皮经肝胆管（囊）穿刺引流胆汁，经引流管向胆管（囊）腔内注入造影剂行胆管腔超声造影检查；同时经外周静脉行肝脏、胆囊和胆管壁血管超声造影检查。结合分析胆道梗阻平面、梗阻程度以及梗阻原因，结果与手术所见和术后病理结果比较。结果双重超声造影胆道梗阻平面的诊断总准确率为98．7％（78／79），梗阻程度总准确率为98．7％（78／79），梗阻病因总准确率为93．7％（74／79）；诊断结果和金标准几乎完全一致（Kappa值分别为0．979、0．837和0．975，P均为0．000）。结合梗阻平面、梗阻程度和梗阻病因，诊断准确率为92．4％（73／79）。结论双重超声造影技术可行、安全、结果可靠，能全面诊断梗阻性黄疸的情况，为选择合理的治疗方案提供依据。

Objective To evaluate the preoperative value of dual contrast-enhanced ultrasound （DCEUS） on obstructive jaundice. Methods Seventy-nine patients with obstructive jaundice were included. DCEUS （percutaneous transhepatic contrast-enhanced cholangio-ultrasonography combined with intra- venous contrast-enhanced ultrasound） was performed preoperatively. The biliary obstruction plane, degree and cause were observed. After surgery, the diagnostic accuracy of DCEUS was compared with final pathologic results respectively. Results The overall accuracy of DCEUS in determining the flat,degree and cause of biliary obstruction was 98.7%,98.7% and 93.7% ,respectively. The DCEUS and ＂golden standard＂ were both almost perfect for assessing biliary obstruction with Kappa values of 0.979,0.837 and 0.975（ P = 0.000）. The overall diagnostic accuracy of obstruction combined with obstruction plane, the extent and cause was 92.4%. Conclusions DCEUS could be considered a feasible, reliable, and exhaustive method for preoperative evaluation of obstructive jaundice.