超声内镜在胆管结石中的诊断价值

Diagnostic value of endoscopic ultrasonography in bile duct stones

目的评价超声内镜(EUS)对胆管结石的诊断价值。方法纳入2014年1月-2017年5月在嘉兴学院医学院附属第二医院肝胆外科行EUS检查的可疑胆管结石患者353例。以内镜逆行胰胆管造影(ERCP)、手术取石或随访结果作为金标准,评价EUS对胆管结石的诊断价值,并与腹部超声(TUS)、CT、磁共振胰胆管造影(MRCP)进行比较。结果 353例患者中EUS诊断胆管结石176例,其中2例经ERCP未见结石;177例EUS检查阴性患者中,17例经验证存在结石。EUS诊断胆管结石的敏感度为91.1%,特异度为98.8%,阳性预测值为98.9%,阴性预测值为90.4%,约登指数89.9%,准确度为94.6%。EUS在胆管大结石(>5 mm)、胆管小结石(≤5 mm)、胆管泥沙样结石、胆管下段结石、胆管中上段结石中均优于TUS和CT。在胆管大结石中EUS与MRCP间差异无统计学意义(P=0.070),在小结石、泥沙样结石、下段结石、中上段结石中EUS均优于MRCP。结论 EUS对胆管结石具有较高的诊断价值,可以作为有创操作前的有效诊断方法。

Objective To evaluate the value of endoscopic ultrasonography(EUS)in the diagnosis of bile duct stones.Methods 353 suspected cholangiolithiasis patients with endoscopic ultrasonography from January 2014 to May 2017 were included.Results of ERCP,surgery or follow-up as the gold standards,then evaluate the value of EUS in diagnosis of bile duct stones,and compared with TUS,CT,MRCP.Results In 353 patients,176 cases were diagnosed with bile duct stones by EUS,of which 2 cases were not seen bile duct stones by ERCP.17 patients proved to be stones in the 177 patients with EUS negative.The diagnostic sensitivity,specificity,positive predictive value,negative predictive value,Youden index,accuracy of EUS to bile duct stones were 91.1%,98.8%,98.9%,90.4%,89.9%,94.6%respectively.Diagnostic efficacy of EUS were superior to TUS and CT in big biliary stones(>5 mm),small bile duct stones(≤5 mm),Sediment-like bile duct stones,lower bile duct stones and upper bile duct stones.There was no statistical difference between EUS and MRCP(P=0.070)in big bile duct stones.EUS was superior to MRCP in small bile duct stones,sediment-like bile duct stones,lower bile duct stones and upper bile duct stones.Conclusion It has great clinical advantage using EUS to diagnose bile duct stone,and it can be used as an effective diagnostic method before invasive operation.