超声内镜诊断胆总管小结石的临床研究
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摘要
目的:探讨超声内镜检查术(EUS)对于胆总管小结石的诊断率及临床价值。方法:回顾性分析行EUS检查患者159例,所有病人结合病史及临床体征考虑为胆总管结石,但影像学检查未发现结石。EUS发现胆总管结石者随即行ERCP取石术;ERCP失败者行手术取石。EUS未发现胆总管结石者,则不行ERCP,但随访至少三个月。结果 :159例患者中EUS发现结石者96例;89例ERCP取石成功,1例ERCP失败者手术取出结石,1例排石,5例为假阳性。63例EUS未发现结石者随访三个月未发现结石。无操作相关并发症发生。超声内镜诊断胆总管小结石的准确性、敏感性、特异性、阳性和阴性预测值分别为96.8%、100%、92.6%、94.8%和100%。结论:超声内镜诊断胆总管小结石安全、可靠。
Objective To determine the diagnostic rate and clinical value of endoscopic ultrasonography(EUS) in patients with choledocholithiasis. Methods Patients with choledocholithiasis who underwent EUS(159 cases) were retrospectively reviewed. All patients were considered as choledocholithiasis by clinical history and signs, but no stones were found in imaging examinations. The patients with choledocholithiasis diagnosed by EUS were treated with ERCP, and ERCP losers were treated with surgery. If EUS found no stones in common bile duct, no ERCP was performed, but the follow-up was continued for at least three months. Results In 159 patients, 96 patients were found common bile duct stone, by EUS, among which 89 cases were successfully removed stone with ERCP, one case was removed stones by surgery, one case sgowed natural stone discharge and five cases showed false positive stones in common bile duct. For those 63 patients without evidence of choledocholithiasis by EUS, no false-negative case was noted during the there-month follow-up period. No operation related complications occurred. The accuracy, sensitivity, specificity, positive and negative predicted values of EUS for the detection of choledocholithiasis were 96.8%, 100%, 92.6%, 94.8% and 100%, respectively. Conclusion EUS is an accurate and safe diagnostic tool for the detection of choledocholithiasis.
Objective To determine the diagnostic rate and clinical value of endoscopic ultrasonography(EUS) in patients with choledocholithiasis. Methods Patients with choledocholithiasis who underwent EUS(159 cases) were retrospectively reviewed. All patients were considered as choledocholithiasis by clinical history and signs, but no stones were found in imaging examinations. The patients with choledocholithiasis diagnosed by EUS were treated with ERCP, and ERCP losers were treated with surgery. If EUS found no stones in common bile duct, no ERCP was performed, but the follow-up was continued for at least three months. Results In 159 patients, 96 patients were found common bile duct stone, by EUS, among which 89 cases were successfully removed stone with ERCP, one case was removed stones by surgery, one case sgowed natural stone discharge and five cases showed false positive stones in common bile duct. For those 63 patients without evidence of choledocholithiasis by EUS, no false-negative case was noted during the there-month follow-up period. No operation related complications occurred. The accuracy, sensitivity, specificity, positive and negative predicted values of EUS for the detection of choledocholithiasis were 96.8%, 100%, 92.6%, 94.8% and 100%, respectively. Conclusion EUS is an accurate and safe diagnostic tool for the detection of choledocholithiasis.
引文
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[2]罗开琴,邓仕军,孙青.实时超声显像对肝外胆管结石诊断的应用价值[J].海南医学,2011,22(5):123-124.
[3]Prachayakul V,Aswakul P,Bhunthumkomol P,et al.Diagnostic yield of endoscopic ultrasonography in patients with intermediate or high likelihood of choledocholithiasis:a retrospective study from one university-based endoscopy center[J].BMC Gastroenterol,2014,14:165.
[4]Tseng CW,Chen CC,Chen TS,et al.Can computed tomography with corronal reconstruction improve the diagnosis of choledocholithiasis[J]?J Gastroenterol Hepatol,2008,23(10):1586-1589.
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[6]de Ledinghen V,Lecene R,Raymond JM,et al.Diagnosis of choledocholithiasis:EUS or magnetic resonance cholangiography?A prospective controlled study[J].Gastrointest Endosc 1999,49:26-31.
[7]Scheiman JM,Carlos RC,Barnett JL,et al.Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease?A prospctive trial and cost analysis[J].AM J Gastroenterol,2001,96:2900-2904.
[8]Palazzo L,Otoole D.EUS in common bile duct stone[J].Gastrointest Endosc,2002,56:49-57.
[9]Sotoudehmanesh R,Khatibian M,Ghadir MR,et al.Diagnostic accuracy of endoscopic ultrasonography in patients with inconclusive magnetic resonance imaging diagnosis of biliopancreatic abnormalities[J].Indian J Gastroenterol,2011,30(4):156-160.
[10]Lisi SD,Leandro G,Buscarini E.Endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis:a systematic review[J].Eur J Gastroenterol Hepatol,2011,23(5):367-374.
[11]Napoléon B,Dumortier J,Keriven-Souquet O,et al.Do normal finding at biliary endoscopic ultrasonography obviate the need for endoscopic retrograde cholangiography in patients with suspicion of common bile duct stone?A prospective follow-up study of 238patients[J].Endoscopy,2003,35(5):411-415.
[12]Caerriere V,Conway J,Evans J,et al.Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?[J]J Interv Gastroenterol,2012,2(4):168-171.
[13]Cui ML,Cho JH,Kim TN.Long-term follow-up study of gallbladder in situ after endoscopic common duct stone removal in Korean patients[J].Surg Endosc,2013,27(5):1711-1716.
[14]Chan HH,Wang EM,Sun MS,et al.Linear echoendoscopeguided ERCP for the diagnosis of occult common bile duct stones[J].BMC Gastroenterol,2013,13:44
[15]Karakan T,Cindoruk M,Alagozlu H,et al.EUS versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones:a prospetive randomized trial[J].Gastrointest Endosc,2009,69(2):244-252.
[16]Lee JH,Lee SR,Lee SY,et al.The usefulness of endoscopic ultrasonography in the diagnosis of choledocholithiasis without common bile duct dilatation[J].Korean J Gastroenterol,2010,56(2):97-102.
[2]罗开琴,邓仕军,孙青.实时超声显像对肝外胆管结石诊断的应用价值[J].海南医学,2011,22(5):123-124.
[3]Prachayakul V,Aswakul P,Bhunthumkomol P,et al.Diagnostic yield of endoscopic ultrasonography in patients with intermediate or high likelihood of choledocholithiasis:a retrospective study from one university-based endoscopy center[J].BMC Gastroenterol,2014,14:165.
[4]Tseng CW,Chen CC,Chen TS,et al.Can computed tomography with corronal reconstruction improve the diagnosis of choledocholithiasis[J]?J Gastroenterol Hepatol,2008,23(10):1586-1589.
[5]Kondo S,Isayama H,Akahane M,et al.Detection of common bile duct stones:comparison between endoscopic ultrasonography,magnetic resonance cholangiography,and helical-computedtomographic cholangiography[J].Eur J Radiol,2005,54(2):271-275.
[6]de Ledinghen V,Lecene R,Raymond JM,et al.Diagnosis of choledocholithiasis:EUS or magnetic resonance cholangiography?A prospective controlled study[J].Gastrointest Endosc 1999,49:26-31.
[7]Scheiman JM,Carlos RC,Barnett JL,et al.Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease?A prospctive trial and cost analysis[J].AM J Gastroenterol,2001,96:2900-2904.
[8]Palazzo L,Otoole D.EUS in common bile duct stone[J].Gastrointest Endosc,2002,56:49-57.
[9]Sotoudehmanesh R,Khatibian M,Ghadir MR,et al.Diagnostic accuracy of endoscopic ultrasonography in patients with inconclusive magnetic resonance imaging diagnosis of biliopancreatic abnormalities[J].Indian J Gastroenterol,2011,30(4):156-160.
[10]Lisi SD,Leandro G,Buscarini E.Endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis:a systematic review[J].Eur J Gastroenterol Hepatol,2011,23(5):367-374.
[11]Napoléon B,Dumortier J,Keriven-Souquet O,et al.Do normal finding at biliary endoscopic ultrasonography obviate the need for endoscopic retrograde cholangiography in patients with suspicion of common bile duct stone?A prospective follow-up study of 238patients[J].Endoscopy,2003,35(5):411-415.
[12]Caerriere V,Conway J,Evans J,et al.Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?[J]J Interv Gastroenterol,2012,2(4):168-171.
[13]Cui ML,Cho JH,Kim TN.Long-term follow-up study of gallbladder in situ after endoscopic common duct stone removal in Korean patients[J].Surg Endosc,2013,27(5):1711-1716.
[14]Chan HH,Wang EM,Sun MS,et al.Linear echoendoscopeguided ERCP for the diagnosis of occult common bile duct stones[J].BMC Gastroenterol,2013,13:44
[15]Karakan T,Cindoruk M,Alagozlu H,et al.EUS versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones:a prospetive randomized trial[J].Gastrointest Endosc,2009,69(2):244-252.
[16]Lee JH,Lee SR,Lee SY,et al.The usefulness of endoscopic ultrasonography in the diagnosis of choledocholithiasis without common bile duct dilatation[J].Korean J Gastroenterol,2010,56(2):97-102.