超声内镜对胆总管小结石的诊断价值

Diagnostic value of endoscopic ultrasonography for small common bile duct stones

摘要:

为评估超声内镜检查术（endoscopic ultrasonography，EUS）对胆总管小结石的诊断价值，纳入2018年1月—2021年7月在东南大学附属中大医院住院并诊断为可疑胆总管结石的患者60例。所有患者于同一次住院期间行EUS及磁共振胰胆管成像（magnetic resonance cholangiopancreatography，MRCP）。以经内镜逆行胰胆管造影、开腹探查或腹腔镜胆总管探查结果为金标准，比较EUS及MRCP对胆总管结石的诊断结果，计算2种检查方法的灵敏度、特异度、阳性预测值、阴性预测值。结果显示，60例患者中46例确诊胆总管结石，EUS诊断准确43例，MRCP诊断准确35例；14例患者证实胆总管结石阴性，EUS诊断准确12例，MRCP诊断准确13例。EUS诊断灵敏度明显高于MRCP［93.48%（43/46）比76.09%（35/46），χ2=4.128，P=0.042］。结石直径≤1.0 cm者45例，其中EUS确诊42例，MRCP确诊34例（诊断准确率93.33%比75.56%，χ2=4.145，P=0.042）；直径≤0.8 cm者39例，其中EUS确诊36例，MRCP确诊28例（诊断准确率92.31%比71.79%，χ2=4.266，P=0.039）；直径≤0.5 cm者26例，其中EUS确诊24例，MRCP确诊16例（诊断准确率92.31%比61.54%，χ2=5.038，P=0.021）。在胆总管结石的诊断方面，EUS有明显的诊断优势，且诊断准确性不受结石大小的影响，因此对于临床高度怀疑胆总管结石但MRCP结果阴性的患者，需进一步行EUS。

Abstract:

To evaluate the diagnostic value of endoscopic ultrasonography (EUS) for small common bile duct stones, 60 patients diagnosed as having suspected common bile duct stones who were hospitalized in Zhongda Hospital, Southeast University from January 2018 to July 2021 were selected. All patients were examined by EUS and magnetic resonance cholangiopancreatography (MRCP) during the same hospitalization. The results of endoscopic retrograde cholangiopancreatography, laparotomy or laparoscopic common bile duct exploration were adopted as the golden standard. The diagnostic results of EUS and MRCP were compared with the golden standard, and the sensitivity, specificity, positive predictive value and negative predictive value of the two methods were calculated. Among the 60 patients, 46 cases were confirmed as having common bile duct stones, 43 cases were diagnosed accurately by EUS and 35 cases by MRCP. Fourteen patients were confirmed as having no common bile duct stones, and the diagnosis was accurate in 12 cases by EUS and 13 cases by MRCP. The sensitivity of EUS was significantly higher than that of MRCP [93.48% (43/46) VS 76.09% (35/46), χ2=4.128, P=0.042]. There were 45 cases with diameter ≤1.0 cm, of which 42 cases were diagnosed by EUS and 34 by MRCP (diagnostic accuracy 93.33% VS 75.56%, χ2=4.145, P=0.042). There were 39 cases with diameter ≤0.8 cm, of which 36 cases were diagnosed by EUS and 28 by MRCP (diagnostic accuracy 92.31% VS 71.79%, χ2=4.266, P=0.039). There were 26 cases with diameter ≤0.5 cm, of which 24 cases were diagnosed by EUS and 16 by MRCP (diagnostic accuracy 92.31% VS 61.54%, χ2=5.038, P=0.021). EUS has obvious advantages in the diagnosis of common bile duct stones, and the accuracy of EUS is not affected by the size of stone. As a consequence, EUS should be performed in patients with high clinical suspicion of common bile duct stones but negative MRCP result.