超声内镜对ERCP术前不明原因胆总管扩张的应用探讨

The application of endoscopic ultrasonography in the diagnosis of unexplained bile duct expansion before endoscopic retrograde cholangiopancreatography

目的探讨超声内镜(EUS)在逆行胆胰管造影术(ERCP)前对不明原因胆总管扩张的诊断价值。方法60例不明原因胆总管扩张患者,经腹部超声(TUS)、CT和(或)磁共振胰胆管造影(MRCP)检查提示胆总管扩张、可疑胆胰病变但原因不明,ERCP术前行EUS检查诊断,并以ERCP、手术病理及随访确诊的结果为最终诊断。结果经ERCP确诊为胆总管下端结石者39例,EUS诊断38例,另1例EUS诊为胆总管下端肿瘤。ERCP及手术病理确诊为胆总管下端肿瘤10例、胆管内乳头状瘤2例、壶腹部肿瘤2例;EUS诊断结果分别为11例、0例及3例,其中1例确诊为胆总管下端结石者EUS提示为胆总管下端肿瘤,2例确诊为胆管内乳头状瘤患者EUS将其中1例诊断为炎性狭窄,另1例诊断为壶腹部肿瘤。术后随访确诊为十二指肠乳头炎性狭窄7例,EUS诊断结果为8例,其中1例术后随访并经ERCP病理确诊为胆管内乳头状瘤。诊断正确率95%(57/60)。结论 EUS对不明原因胆总管扩张的定位及定性诊断均有很高的诊断价值,特别是能提高胆总管下端结石确诊率,高于MRCP检查,并能指导选择性地进行ERCP,提高治疗效果,减少风险。

Objective To evaluate the diagnostic value of endoscopic ultrasonography （EUS） for unexplained bile duct expansion in patients before retrograde cholangiopancreatography （ERCP）. Methods Sixty patients with unknown causes of bile duct dilatation were included in this study. Patients were examined by abdominal ultrasound （TUS）, CT and （or） magnetic resonance imaging （MRCP） suggesting the dilatation of common bile duct, suspecting biliary pancreatic disease with unknown cause. EUS diagnosis was performed before ERCP surgery. The final diagnosis was confirmed by ERCP, pathology and follow-up diagnosis. Results Thirty-nine patients were diagnosed as distal bile duct stone by ERCP, 38 were diagnosed by EUS, and one case was diagnosed as common bile duct bottom tumors by EUS. There were 10 cases were diagnosed as common bile duct bottom tumors by ERCP and surgical pathology, 2 cases were diagnosed as biliary papillomatosis, 2 cases were diagnosed as periampullary carcinoma. There were 11, 0 and 3 cases were diagnosed by EUS. One case was diagnosed as distal bile duct stone, which was diagnosed as common bile duct bottom tumor by EUS. Two cases were diagnosed as papillary tumor of the bile duct, one of which was diagnosed as inflammatory stenosis, another one was diagnosed as periampullary carcinoma by EUS. Results of postoperative follow-up confirmed that 7 cases were duodenal papilla inflammatory stenosis. Eight cases were diagnosed by EUS, one of them was followed up and pathologically diagnosed as biliary papillomatosis by ERCP. The diagnostic accuray was 95%（57/60）. Conclusion EUS has higher value in the diagnosis of unexplained bile duct expansion, which especially can improve the diagnostic rate of distal bile duct stone compared with that of MRCP detection, and can guide selectively ERCP, improve the therapeutic effect, and reduce its risk .