超声内镜在胰管结石诊断中的价值

Diagnostic value of endoscopic ultrasonography in pancreatic duct stones

目的探讨超声内镜对胰管结石的诊断价值。方法回顾性分析2019年1月至2023年4月在西部战区总医院因腹痛、腹胀、黄疸等疑似诊断胰管结石而行超声内镜检查的204例患者资料。最终入组159例患者,其中男性112例,女性47例,年龄(51.5±13.9)岁。以手术/ERCP诊断的胰管结石为"金标准"。38例(23.9%)患者同时行腹部超声、143例(89.9%)同时行CT检查、93例(58.5%)同时行MRCP检查,比较四种影像学检查诊断胰管结石的准确率。结果159例患者经手术/ERCP诊断胰管结石61例(38.4%),无胰管结石98例(61.6%)。159例患者中超声内镜诊断胰管结石61例(38.4%),98例(61.6%)无胰管结石,超声内镜诊断胰管结石的灵敏度98.4%、特异度99.0%、阳性预测值98.4%、阴性预测值99.0%、约登指数97.3%、准确率98.7%。超声内镜检查诊断胰管结石准确率优于腹部超声、CT、MRCP,差异均有统计学意义(χ2=7.71、13.76、5.70,P=0.012、P<0.001、P=0.033)。超声内镜与手术/ERCP诊断胰管结石一致性较好(Kappa=0.854,P=0.000)。结论超声内镜对胰管结石有较高的诊断价值,可作为疑似胰管结石的首选影像学检查手段。

Objective To investigate the diagnostic value of endoscopic ultrasonography(EUS)in pancreatic duct stones.Methods The clinicopathologic data of 204 patients undergoing EUS for symptoms such as abdominal pain,abdominal distension and jaundice suspected of pancreatic duct stones,who were admitted to the General Hospital of Western Theater Command from January 2019 to April 2023 were retrospectively analyzed.Of 159 patients were finally enrolled,including 47 females and 112 males,aged(51.8±13.9)years.Surgery or endoscopic retrograde cholangiopancreatography(ERCP)is considered the"gold standard"for the diagnosis of pancreatic duct stones.Of 38 patients(23.9%)had abdominal ultrasound,143(89.9%)had CT scan and 93(58.5%)had magnetic resonance cholangiopancreatography(MRCP)at the same time.The diagnostic accuracy of imaging examinations in pancreatic duct stones was compared.Results In 159 patients,61(38.4%)were diagnosed of pancreatic duct stones.In the 159 patients,61(38.4%)were diagnosed of pancreatic duct stones by EUS.The diagnostic sensitivity,specificity,positive predictive value,negative predictive value,Youden index and accuracy of EUS for pancreatic duct stones were 98.4%,99.0%,98.4%,99.0%,97.3%and 98.7%,respectively.The accuracy of EUS in diagnosing pancreatic duct stones was higher than that of percutaneous ultrasound,CT and MRCP(χ2=7.71,13.76,and 5.70,P=0.012,<0.001,0.033).The diagnostic accuracy of EUS is comparable with operation and ERCP(Kappa=0.854,P<0.001).Conclusion EUS could be a superior imaging approach to diagnose the pancreatic duct stone.