经胆管腔内超声造影在胆道梗阻程度评估中的应用价值
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摘要
目的探讨经胆管腔内超声造影(IB-CEUS)在评估胆道梗阻程度中的临床应用价值。方法回顾性分析2008年1月至2012年12月在中山大学附属第三医院诊治的105例胆道梗阻性病变患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男74例,女31例;年龄30~88岁,中位年龄55岁。采用常规超声检查(CUS)和IB-CEUS分别探查105例胆道梗阻性病变患者,以X线或CT胆道造影结果为金标准,比较两种方法的诊断效能。采用Mc Nemar检验评价两种方法对于胆管梗阻程度的诊断与金标准之间的差异性,采用Kappa一致性评价结果的一致性。结果对肝内一级、二级胆管完全性梗阻的诊断,两种方法诊断的敏感度及阴性预测值一致,均为100%。IB-CEUS对肝内一级胆管完全性梗阻诊断的特异度、阳性预测值、准确率分别为95.8%、91.9%、97.1%,高于CUS的57.7%、53.1%、71.4%;IB-CEUS对肝内二级胆管完全性梗阻诊断的特异度、阳性预测值、准确率分别为97.3%、83.3%、97.6%,高于CUS的58.6%、24.6%、63.5%。CUS与金标准比较,诊断差异有统计学意义(χ~2=28.033,46.000;P<0.05),其对肝内一级、二级胆管完全性梗阻诊断的一致性一般或差(k=0.470,0.252);而IB-CEUS与金标准诊断比较,差异无统计学意义(P=0.250),且结果一致性好(k=0.936,0.896)。结论 IB-CEUS能够较准确地评估肝内胆道梗阻程度,效能优于CUS,且与金标准诊断一致性好。
Objective To evaluate the clinical application value of intra-biliary contrast-enhanced ultrasound(IB-CEUS) in the evaluation of degree of biliary obstruction. Methods Clinical data of 105 patients with biliary obstructive disease who were diagnosed and treated in the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to December 2012 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 74 males and 31 females with the age ranging from 30 to 88 years old and the median age of55 years old. Conventional ultrasound(CUS) and IB-CEUS were used to detect the biliary obstructive lesions in 105 patients. X-ray or CT cholangiography was used as the gold standard for diagnosis. The diagnostic efficacy of two methods was compared. The differences between these two methods and the gold standard in diagnosing the degree of biliary obstruction were evaluated by Mc Nemar test. The consistency of the results was assessed by Kappa consistency. Results The diagnostic sensitivity and negative predictive value of two methods were 100% in diagnosing the complete obstruction of primary and second grade intrahepatic bile ducts. The specificity, positive predictive value and accuracy of IB-CEUS in diagnosing the complete obstruction of primary grade intrahepatic bile ducts was respectively 95.8%,91.9% and 97.1%, higher than 57.7%, 53.1% and 71.4% of CUS. The specificity, positive predictive value and accuracy of IB-CEUS in diagnosing the complete obstruction of second grade intrahepatic bile ducts was respectively 97.3%, 83.3% and 97.6%, higher than 58.6%, 24.6% and 63.5% of CUS.Significant difference was observed in the diagnosis between CUS and gold standard(χ~2=28.033,46.000; P<0.05). CUS was fair or poor for the consistency of results in diagnosing the complete biliary obstruction of primary and second grade intrahepatic bile ducts(k=0.470, 0.252), while no significant difference was observed between IB-CEUS and gold standard(P=0.250) and the consistency of results was good(k=0.936, 0.896). Conclusions IB-CEUS can accurately evaluate the degree of intrahepatic biliary obstruction. The efficacy of IB-CEUS is better than that of CUS, and it has a good diagnostic consistency with the gold standard.
Objective To evaluate the clinical application value of intra-biliary contrast-enhanced ultrasound(IB-CEUS) in the evaluation of degree of biliary obstruction. Methods Clinical data of 105 patients with biliary obstructive disease who were diagnosed and treated in the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to December 2012 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 74 males and 31 females with the age ranging from 30 to 88 years old and the median age of55 years old. Conventional ultrasound(CUS) and IB-CEUS were used to detect the biliary obstructive lesions in 105 patients. X-ray or CT cholangiography was used as the gold standard for diagnosis. The diagnostic efficacy of two methods was compared. The differences between these two methods and the gold standard in diagnosing the degree of biliary obstruction were evaluated by Mc Nemar test. The consistency of the results was assessed by Kappa consistency. Results The diagnostic sensitivity and negative predictive value of two methods were 100% in diagnosing the complete obstruction of primary and second grade intrahepatic bile ducts. The specificity, positive predictive value and accuracy of IB-CEUS in diagnosing the complete obstruction of primary grade intrahepatic bile ducts was respectively 95.8%,91.9% and 97.1%, higher than 57.7%, 53.1% and 71.4% of CUS. The specificity, positive predictive value and accuracy of IB-CEUS in diagnosing the complete obstruction of second grade intrahepatic bile ducts was respectively 97.3%, 83.3% and 97.6%, higher than 58.6%, 24.6% and 63.5% of CUS.Significant difference was observed in the diagnosis between CUS and gold standard(χ~2=28.033,46.000; P<0.05). CUS was fair or poor for the consistency of results in diagnosing the complete biliary obstruction of primary and second grade intrahepatic bile ducts(k=0.470, 0.252), while no significant difference was observed between IB-CEUS and gold standard(P=0.250) and the consistency of results was good(k=0.936, 0.896). Conclusions IB-CEUS can accurately evaluate the degree of intrahepatic biliary obstruction. The efficacy of IB-CEUS is better than that of CUS, and it has a good diagnostic consistency with the gold standard.
引文
[1]van der Gaag NA,Kloek JJ,de Castro SM,et al.Preoperative biliary drainage in patients with obstructive jaundice:history and current status[J].J Gastrointest Surg,2009,13(4):814-820.
[2]Saad WE,Wallace MJ,Wojak JC,et al.Quality improvement guidelines for percutaneous transhepatic cholangiography,biliary drainage,and percutaneous cholecystostomy[J].J Vasc Interv Radiol,2010,21(6):789-795.
[3]Moole H,Dharmapuri S,Duvvuri A,et al.Endoscopic versus percutaneous biliary drainage in palliation of advanced malignant hilar obstruction:a meta-analysis and systematic review[J].Can JGastroenterol Hepatol,2016:4726078.
[4]Sutter CM,Ryu RK.Percutaneous management of malignant biliary obstruction[J].Tech Vasc Interv Radiol,2015,18(4):218-226.
[5]蔡丽萍,王琳,赵克立,等.胆管超声造影在肝内胆管置管引流术式选择中的应用价值[J/CD].中华临床医师杂志(电子版),2011,5(8):2476-2477.
[6]Rerknimitr R,Angsuwatcharakon P,Ratanachu-ek T,et al.Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma[J].J Gastroenterol Hepatol,2013,28(4):593-607.
[7]Foley WD,Quiroz FA.The role of sonography in imaging of the biliary tract[J].Ultrasound Q,2007,23(2):123-135.
[8]许尔蛟,张曼,任杰,等.经胆管腔内超声造影的临床应用价值[J/CD].中华肝脏外科手术学电子杂志,2013,2(6):379-382.
[9]许尔蛟,郑荣琴,李凯,等.胆管内超声造影在经皮经肝胆道引流术中的应用价值[J/CD].中华医学超声杂志(电子版),2011,8(9):1937-1945.
[10]Xu EJ,Zheng RQ,Su ZZ,et al.Intra-biliary contrast-enhanced ultrasound for evaluating biliary obstruction during percutaneous transhepatic biliary drainage:a preliminary study[J].Eur J Radiol,2012,81(12):3846-3850.
[11]Park HS,Lee JM,Choi JY,et al.Preoperative evaluation of bile duct cancer:MRI combined with MR cholangiopancreatography versus MDCT with direct cholangiography[J].AJR Am J Roentgenol,2008,190(2):396-405.
[12]Choi JY,Kim MJ,Lee JM,et al.Hilar cholangiocarcinoma:role of preoperative imaging with sonography,MDCT,MRI,and direct cholangiography[J].AJR Am J Roentgenol,2008,191(5):1448-1457.
[13]Kim HJ,Kim AY,Hong SS,et al.Biliary ductal evaluation of hilar cholangiocarcinoma:three-dimensional direct multi-detector row CTcholangiographic findings versus surgical and pathologic results--feasibility study[J].Radiology,2006,238(1):300-308.
[14]Hyodo T,Kumano S,Kushihata F,et al.CT and MRcholangiography:advantages and pitfalls in perioperative evaluation of biliary tree[J].Br J Radiol,2012,85(1015):887-896.
[15]Wagner A,Mayr C,Kiesslich T,et al.Reduced complication rates of percutaneous transhepatic biliary drainage with ultrasound guidance[J].J Clin Ultrasound,2017,45(7):400-407.
[16]Piscaglia F,Nols?e C,Dietrich CF,et al.The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound(CEUS):update 2011 on non-hepatic applications[J].Ultraschall Med,2012,33(1):33-59.
[17]许尔蛟,李凯,郑荣琴,等.三维经胆道超声造影对肝门部胆管癌的诊断价值的初步研究[J].中山大学学报(医学科学版),2015,36(1):150-153.
[18]许尔蛟,苏中振,郑荣琴,等.经静脉联合经胆道超声造影在肝门部胆管癌分型诊断中的价值[J].中华超声影像学杂志,2013,22(4):325-328.
[19]Heinzmann A,Müller T,Leitlein J,et al.Endocavitary contrast enhanced ultrasound(CEUS)--work in progress[J].Ultraschall Med,2012,33(1):76-84.
[20]吴勇超,荣小翠,武中林,等.不同胆道引流方式对高位恶性胆道梗阻疗效的影响[J].肿瘤防治研究,2017,44(2):133-137.
[2]Saad WE,Wallace MJ,Wojak JC,et al.Quality improvement guidelines for percutaneous transhepatic cholangiography,biliary drainage,and percutaneous cholecystostomy[J].J Vasc Interv Radiol,2010,21(6):789-795.
[3]Moole H,Dharmapuri S,Duvvuri A,et al.Endoscopic versus percutaneous biliary drainage in palliation of advanced malignant hilar obstruction:a meta-analysis and systematic review[J].Can JGastroenterol Hepatol,2016:4726078.
[4]Sutter CM,Ryu RK.Percutaneous management of malignant biliary obstruction[J].Tech Vasc Interv Radiol,2015,18(4):218-226.
[5]蔡丽萍,王琳,赵克立,等.胆管超声造影在肝内胆管置管引流术式选择中的应用价值[J/CD].中华临床医师杂志(电子版),2011,5(8):2476-2477.
[6]Rerknimitr R,Angsuwatcharakon P,Ratanachu-ek T,et al.Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma[J].J Gastroenterol Hepatol,2013,28(4):593-607.
[7]Foley WD,Quiroz FA.The role of sonography in imaging of the biliary tract[J].Ultrasound Q,2007,23(2):123-135.
[8]许尔蛟,张曼,任杰,等.经胆管腔内超声造影的临床应用价值[J/CD].中华肝脏外科手术学电子杂志,2013,2(6):379-382.
[9]许尔蛟,郑荣琴,李凯,等.胆管内超声造影在经皮经肝胆道引流术中的应用价值[J/CD].中华医学超声杂志(电子版),2011,8(9):1937-1945.
[10]Xu EJ,Zheng RQ,Su ZZ,et al.Intra-biliary contrast-enhanced ultrasound for evaluating biliary obstruction during percutaneous transhepatic biliary drainage:a preliminary study[J].Eur J Radiol,2012,81(12):3846-3850.
[11]Park HS,Lee JM,Choi JY,et al.Preoperative evaluation of bile duct cancer:MRI combined with MR cholangiopancreatography versus MDCT with direct cholangiography[J].AJR Am J Roentgenol,2008,190(2):396-405.
[12]Choi JY,Kim MJ,Lee JM,et al.Hilar cholangiocarcinoma:role of preoperative imaging with sonography,MDCT,MRI,and direct cholangiography[J].AJR Am J Roentgenol,2008,191(5):1448-1457.
[13]Kim HJ,Kim AY,Hong SS,et al.Biliary ductal evaluation of hilar cholangiocarcinoma:three-dimensional direct multi-detector row CTcholangiographic findings versus surgical and pathologic results--feasibility study[J].Radiology,2006,238(1):300-308.
[14]Hyodo T,Kumano S,Kushihata F,et al.CT and MRcholangiography:advantages and pitfalls in perioperative evaluation of biliary tree[J].Br J Radiol,2012,85(1015):887-896.
[15]Wagner A,Mayr C,Kiesslich T,et al.Reduced complication rates of percutaneous transhepatic biliary drainage with ultrasound guidance[J].J Clin Ultrasound,2017,45(7):400-407.
[16]Piscaglia F,Nols?e C,Dietrich CF,et al.The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound(CEUS):update 2011 on non-hepatic applications[J].Ultraschall Med,2012,33(1):33-59.
[17]许尔蛟,李凯,郑荣琴,等.三维经胆道超声造影对肝门部胆管癌的诊断价值的初步研究[J].中山大学学报(医学科学版),2015,36(1):150-153.
[18]许尔蛟,苏中振,郑荣琴,等.经静脉联合经胆道超声造影在肝门部胆管癌分型诊断中的价值[J].中华超声影像学杂志,2013,22(4):325-328.
[19]Heinzmann A,Müller T,Leitlein J,et al.Endocavitary contrast enhanced ultrasound(CEUS)--work in progress[J].Ultraschall Med,2012,33(1):76-84.
[20]吴勇超,荣小翠,武中林,等.不同胆道引流方式对高位恶性胆道梗阻疗效的影响[J].肿瘤防治研究,2017,44(2):133-137.
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