内镜超声检查术对胰腺肿瘤早期诊断的价值

目的探讨内镜超声检查术（EUS）、管内超声检查术（IDUS）及超声内镜引导下细针穿刺术（EUS-FNA）对胰腺肿瘤早期诊断的价值。方法回顾性分析和比较188例胰腺小占位病灶的EUS、IDUS、EUS—FNA及其他影像学检查结果。结果（1）EUS诊断小胰腺癌的准确率是95．6％（44／46）,优于B超58．6％（27／46）、CT77．4％（24／31）、MRI76．2％（16／21）及内镜逆行胰胆管造影术（ERCP）85．3％（29／34）。小胰腺癌EUS声像图主要表现为类圆形、边界清楚、边缘不规则的低回声肿块,内部回声多均匀。（2）25例胰腺小占位病灶行IDUS检查,其准确率是100．0％（25／25）,明显优于B超32．0％（8／25）、CT52．9％（9／17）及MRI57．9％（11／19）等检查。（3）18例胰腺小占位病灶行EUS—FNA,其准确率是66．7％（12／18）。（4）EUS诊断胰腺假性囊肿的准确率是100．0％（27／27）,明显优于13超52．0％（13／25）、CT66、7％（12／18）、MRI82．4％（14／17）及ERCP78．9％（15／19）;对胰腺囊性肿瘤分类鉴别诊断总的准确率是57．7％（15／26）,优于B超19．2％（5／26）、CT36．4％（8／22）、MRI37．5％（6／16）及ERCP50．0％（7／14）等检查。结论EUS、IDUS及EUS-FNA对胰腺肿瘤的早期诊断具有重要价值。     

影像学检查在胰腺癌诊断中的作用

目的 提高临床胰腺癌的确诊率。方法 回顾性分析北京协和医院1996年至2004年间256例资料完整胰腺癌患者的临床表现及各种影像学检查结果，包括B超、CT、ERCP、超声内镜检查（EUS）、血管造影（DSA）、MRI等。结果 体重减轻是胰腺癌患者最多见的症状，发生率达79％；除体重减轻外，胰头癌最突出的症状是黄疸，而上腹痛在体尾癌的发生率达86％。B超、CT、ERCP、EUS、DSA、MRI对胰腺癌诊断的准确率分别为83％、89％、90％、91％、82％、79％。结论 患者出现不能解释的上腹痛、黄疸、体重减轻等症状时应怀疑有胰腺癌，并进行B超、CT检查，对高度怀疑而前两者检查阴性者应考虑进一步行EUS、ERCP或MRI等检查。     

内镜超声对胰腺癌的诊断

目的 探讨内镜超声（EUS）检查对胰腺癌的诊断价值。方法 对116例胰腺癌患者行EUS检查，其中16例经管内超声（IDUS）检查并与体表B超（B超），CT，磁共振成像（MRI），内镜逆行胰胆管造影（ERCP）检查结果进行比较。结果 EUS（IDUS)诊断胰腺癌的敏感性与准确性均明显高于B超，与CT，MRI及ERCP相当，EUS诊断准确率为98．2％（114／116），IDUS为100％（16／16）；CT为85．3％（99／116）；MRI为87．0％（54／62）；ERCP为80．6％（79／98）；B超为73．2％（85／116）。结论 EUS对胰腺癌有较大的诊断价值。     

超声内镜对胆胰疾病诊断价值的探讨

目的 探讨超声内镜（EUS）对胆胰疾病的诊断价值。方法 采用超声胃镜（频率为7．5MHz和20Mnz），应用水囊法结合水充盈法，对54例临床疑为胆胰病变的患者进行EUS检查，并与腹部B超、CT及ERCP比较。结果 EUS、US、CT、ERCP对胆胰疾病诊断的阳性率分别为92．6％（50/54）、57．4％（31／54）、64．8％（35／54）及76．2％（32／42）。EUS对胰腺癌诊断的阳性率达100％。高于腹部B超、CT及ERCP；EUS对胆总管结石及慢性胰腺炎的准确率分别为100％和88．9％。结论 EUS对胆胰疾病的诊断率高于腹部B超，CT及ERCP影像检查，尤其对胆管扩张病因的定位及定性诊断均有较大的诊断价值。     

超声内镜对胰腺癌诊断及评估价值

目的探讨EUS诊断胰腺癌的敏感性、准确性及其评估肿瘤特征的价值.方法以126例经病理确诊并在确诊前半月内先后接受EUS、US、CT检查的胰腺癌患者为研究对象,回顾性分析三种成像方法及EUS对于不同类型胰腺癌的检查结果,应用t检验或u检验评估这些检查结果的差异有无显著性.结果 EUS诊断胰腺癌准确性较US高,尤其对于小胰腺癌准确性更高,二者差异有显著性(P<0.05);EUS诊断敏感性、准确性与CT比较差异无显著性;联合应用EUS及CT检查,则诊断敏感性及准确性大为提高,与单独应用US、EUS或CT相比,差异均有显著性(P<0.05);EUS与CT显示肿瘤间接征象的准确性无显著性差异.结论 EUS对于胰腺癌是一种较好的检查方法,尤其对于怀疑为小胰腺癌者应作为常规检查.联合应用EUS和CT检查胰腺癌值得推广.     

多种内镜检查方法联合应用对胆管狭窄性疾病的诊断价值

目的评估多种内镜检查方法联合应用对胆管狭窄性疾病的诊疗价值。方法回顾性分析36例胆管狭窄性疾病患者的诊断情况。36例患者均进行了超声内镜检查术（EUS）、经内镜逆行胰胆管造影术（ERCP）、胆管内超声检查术（IDUS）,胆道靶向刷检行细胞学涂片、液基薄层细胞学检查,并结合临床资料及组织学病理检查,综合诊断。结果最终诊断胆管恶性病变21例,其中胆管细胞癌9例、十二指肠乳头癌4例、胰腺癌侵犯胆总管4例、肝癌侵犯胆总管4例;胆管良性病变15例,其中胆总管结石9例、肝吸虫感染所致胆管狭窄4例、单纯胆管炎性狭窄1例、外部压迫所致胆管狭窄1例。EUS、ERCP、IDUS及ERCP＋IDUS对胆管狭窄性疾病鉴别诊断的准确率分别为77．8％、88．9％、91．7％、94．4％,ERCP、IDUS及ERCP＋IDUS均明显高于EUS（P均〈0．05）;ERCP＋IDUS对胆管狭窄性疾病鉴别诊断的敏感度、特异度、阳性预测值与阴性预测值分别为95．2％、93．3％、95．2％、93．3％,均高于EUS、ERCP及IDUS单独检查。胆道刷检细胞学、液基薄层细胞学或组织病理学检查,19例诊断为恶性狭窄,17例诊断为良性狭窄,对鉴别胆管狭窄性质诊断的敏感度为90．5％、特异度为100．0％、准确率为94．4％。结论对于胆管狭窄性病变,ERCP＋IDUS可使诊断准确率得到明显提高;联合应用ERCP＋IDUS＋病变胆管的靶向刷检等多种内镜检查方法,诊断准确率更高。     

低位梗阻性黄疸的影像与内镜诊断价值探讨

目的探讨影像与内镜检查在低位梗阻性黄疸中的诊断价值及科学组合与合理应用。方法回顾分析57例低位梗阻性黄疸患者的病因及体表超声（US）、cT、MRI＋MRCP、ERCP和EUS等诊断结果,总结各检查方法在低位梗阻性黄疸诊断中的适应证和诊断价值。结果57例低位梗阻性黄疸患者中,良性梗阻42例,其中胆总管结石38例,胆总管蛔虫1例,胆道术后良性狭窄2例,胰头部慢性胰腺炎1例;恶性梗阻15例,其中胰头癌11例,壶腹癌4例。US、CT、MRI＋MRCP、ERCP、EUS对低位梗阻性黄疸的定位诊断准确率分别为71．93％（41／57）、88．00％（22／25）、94．59％（35／37）、100．00％（47／47）、96．77％（30／31）;定性诊断准确率分别为63．16％（36／57）、80．00％（20／25）、83．78％（31／37）、100．00％（47／47）、96．77％（30／31）。结论良性病变是低位梗阻性黄疸的主要原因,但恶性病变并不少见,影像或内镜检查对于明确诊断至关重要,策略性、程序性选择应用各种检查方法,尤为必要。     

超声内镜诊断胆总管结石的临床价值分析

目的比较超声内镜（EUS）与B型超声波（US）、CT、磁共振胰胆管成像（MRCP）、内镜逆行胰胆管造影（ERCP）诊断胆总管结石的临床价值。方法对经手术及病理证实的96例胆总管结石患者的EUS、US、CT、MRCP、ERCP检查进行回顾性分析,比较其诊断胆总管结石的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）及准确率。结果 EUS诊断敏感性、特异性、PPV、NPV及准确率均显著高于US（P〈0.05）,敏感性和准确率均显著高于CT（P〈0.05）,各项诊断指标与MRCP和ERCP比较无显著差异。结论 EUS诊断胆总管结石具有准确性和安全性高等优点,与US、CT、MRCP及ERCP相比具有一定优势。     

内镜超声检查对胆囊癌的诊断价值

目的探讨内镜超声检查(EUS)对胆囊癌的诊断价值。方法对18例胆囊癌患者行EUS 检查并与体表B超(B超),X线电子计算机断层扫描(CT)/磁共振成像(MRI)结果进行比较。结果18例中EUS诊断17例,CT/MRI诊断15例,B超诊断5例。EUS诊断胆囊癌的敏感性与准确性高于B超,与CT/MRI相当。13例行手术治疗,与手术病理组织检查比较,EUS诊断正确率为92％,CT/MRI为76.9％,差异无显著性(P＞0.05)。B超为41.6％,差异有非常显著性(P＜0.01)。EUS对小病灶的显示明显优于B超,并优于CT/MRI。结论EUS对胆囊癌有较高的诊断价值。     

超声内镜对胰管扩张性疾病的诊断价值

目的探讨内镜超声检查术(EUS)在胰管扩张病因及恶性疾病邻近脏器浸润的诊断价值.方法分析129例EUS检查发现胰管扩张的病因,并与同期接受CT检查(n=40)与ERCP检查(n=42)的结果相比较.对其中72例胰腺癌引起的胰管扩张病例,分析EUS对邻近脏器浸润检出率,并与CT、ERCP结果相比较.结果 129例胰管扩张病例中,胰腺癌、壶腹癌、慢性胰腺炎为常见病因.EUS对病因检出率较CT及ERCP高.EUS对胰腺癌邻近血管侵犯及淋巴结转移检出率较CT及ERCP高.结论 EUS对胰管扩张的病因诊断较CT及ERCP有明显的优越性,并能全面评估肿瘤的可切除性,指导制定治疗方案.     

Endoscopic papillectomy: Indications,techniques, and results

Endoscopic papillectomy(EP) is currently accepted as a viable alternative therapy to surgery in sporadic ampullary adenoma and has been reported to have high success and low recurrence rates. At present, the indications for EP are not yet fully established. The accepted criteria for EP include size(up to 5 cm), no evidence of intraductal growth, and no evidence of malignancy on endoscopic findings(ulceration, friability, and spontaneous bleeding). Endoscopic ultrasound(EUS) is the imaging modality of choice for local T staging in ampullary neoplasms. Data reported in the literature have revealed that linear EUS is superior to helical computed tomography in the preoperative assessment of tumor size, detection of regional nodal metastases and detection of major vascular invasion. Endoscopic ampullectomy is performed using a standard duodenoscope in a similar manner to snare polypectomy of a mucosal lesion. There is no standardization of the equipment or technique and broad EP methods are described. Endoscopic ampullectomy is considered a "high-risk’’ procedure due to complications. Complications of endoscopic papillectomy can be classified as early(pancreatitis, bleeding, perforation, and cholangitis) and late(papil-lary stenosis) complications. The appropriate use of stenting after ampullectomy may prevent post-procedural pancreatitis and papillary stenosis. Tumor recurrence of benign lesions occurs in up to 20% of patients and depends on tumor size, final histology, presence of intraductal tumor, coexisting familial adenomatous polyposis(FAP), and the expertise of the endoscopist. Recurrent lesions are usually benign and most can be retreated endoscopically.     

Endoscopic ultrasonography guided drainage:Summary of consortium meeting,May 21,2012,San Diego,California

Endoscopic retrograde cholangiopancreatography(ERCP) is the preferred procedure for biliary and pancreatic drainage.While ERCP is successful in about 95% of cases,a small subset of cases are unsuccessful due to altered anatomy,peri-ampullary pathology,or malignant obstruction.Endoscopic ultrasound-guided drainage is a promising technique for biliary,pancreatic and recently gallbladder decompression,which provides multiple advantages over percutaneous or surgical biliary drainage.Multiple retrospective and some prospective studies have shown endoscopic ultrasoundguided drainage to be safe and effective.Based on the currently reported literature,regardless of the approach,the cumulative success rate is 84%-93% with an overall complication rate of 16%-35%.endoscopic ultrasoundguided drainage seems a viable therapeutic modality for failed conventional drainage when performed by highly skilled advanced endoscopists at tertiary centers with expertise in both echo-endoscopy and therapeutic endoscopy     

内镜十二指肠乳头切开联合腹腔镜胆囊切除术治疗胆囊结石并胆总管结石

目的探讨运用腹腔镜胆囊切除术联合内镜十二指肠乳头切开术治疗胆囊结石并胆总管结石的方法。方法对胆囊结石并胆总管结石患者,92例行开腹胆囊切除 胆总管切开取石、T管引流术,86例行内镜下十二指肠乳头切开术(EST) 腹腔镜胆囊切除术(LC)。比较两种术式的临床效果、住院时间、并发症等。结果开腹组术中结石取净率为94.8%,住院时间为23.8±7.6d,术后并发胆瘘2例,肝功能衰竭1例,腹腔感染3例,肺部感染1例。内镜组有4例取石失败,改行开腹手术,余均取石成功,取石成功率为94%,住院时间为10.2±5.3d,并发胆道感染2例,十二指肠乳头出血3例。结论与传统开腹胆囊切除 胆总管切开取石、T管引流术相比,EST LC治疗胆囊结石并胆总管结石具有创伤小、住院时间短、患者恢复快、并发症少等优点,临床效果可靠。EST与LC的联合应用可替代大部分开腹胆囊切除 胆总管切开取石、T管引流术。     

Successful outcomes of EMR-L with 3D-EUS for rectal carcinoids compared with historical controls

AIM： To assess the results of endoscopic mucosal resection with a ligation device （EMR-L） combined with three dimensional endoscopic ultrasonography （3D- EUS） using an ultrasonic probe for rectal carcinoids. In addition, diagnosis of the depth and size of lesions by EUS was evaluated.
METHODS： Between January 2003 and March 2007, 20 patients underwent EMR-L with 3D-EUS using an ultrasonic probe （group A）. 3D-EUS was combined with EMR-L at the time of injection of sterile physiological saline into the submucosal layer. For comparison, 14 rectal carcinoids that had been treated by EMR-L without 3D-EUS between April 1998 and December 2002 were evaluated as historical controls （group B）. EUS was conducted for all of the patients before treatment to evaluate tumor diameter and depth of invasion. The percentage of complete resection and the vertical resection margin were compared between the two groups.
RESULTS： The depth of invasion upon histopathological examination was in complete agreement with the pre-operative findings by EUS. The tumor diameter determined by EUS approximated that found in the tissue samples. There were no significant differences in the gender, tumor sites or tumor diameters between the two groups. The rate of complete resection for groups A and B was 100% and 71%, respectively （P 〈 0.05）. The vertical resection margin of group A was longer than that of group B.
CONCLUSION： EMR-L is effective as an endoscopic treatment for rectal carcinoids. In combination with 3D-EUS, safe and complete resection is further assured.     

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目的提高对胃异位胰腺的诊断及治疗水平。方法2000-2004年对解放军总医院消化科241例胃黏膜下肿物进行超声内镜(EUS)检查,回顾分析胃异位胰腺的图像特征。结果EUS诊断良性间质瘤105例,恶性间质瘤23例,脂肪瘤48例,异位胰腺45例,囊肿20例。异位胰腺EUS图像特点:(1)黏膜下层病变39例,6例与固有肌层无分界;(2)边界清37例;(3)42例为不均匀、形状不规则中强回声,3例为不均匀低回声;(4)32例中心有小的不规则液性回声。内镜电切26例,无出血穿孔等并发症。结论超声内镜对胃异位胰腺的诊断有一定价值,内镜切除是安全有效的治疗方法。     

超声内镜对食管静脉曲张结扎术前后侧枝循环变化的临床研究

目的 应用Fujinon SP-701小探头超声内镜观察食管静脉曲张结扎术(EVL)前后曲张静脉及侧枝循环的变化，分析影响疗效的原因。选择合理的治疗方法。方法 对60例单纯食管静脉曲张出血患者依超声检查结果分为3组：Ⅰ组为单纯食管静脉曲张(EV)；Ⅱ组为合并有食管旁静脉(PEV)，但无交通枝(PV)；Ⅲ组合并有食管旁静脉及交通枝。患者EVL术后4、8、12周行超声内镜检查，观察及测量EV、PEV、PV的变化情况，分析影响疗效的原因。结果 Ⅰ组显效率75％，复发率16％，疗效最佳；Ⅲ组显效率0％，复发率100％，疗效最差。Ⅰ组24例中出现PEV者12例；Ⅱ组20例PEV全部增宽，11例出现PV；Ⅲ组全部有PEV增宽、PV增多增宽表现。结论 超声内镜对食管静脉曲张出血治疗方法的选择有指导意义。单纯食管静脉曲张EVL可获得满意疗效，但是伴PEV及PV者不是EVL适应证，建议采用其他方法治疗。     

ERCP结合EPT对胆囊切除术后患者诊治价值的探讨

目的 回顾性研究逆行性胰胆管造影（ERCP）结合乳头肌切开术（EPT）对胆囊切除术后患者的诊治价值。方法 170例胆囊切除术后症状再发或反复发作患者，接受ERCP检查和EPT等治疗，诊断结果与B超作对照。同时动态观察内镜下介入诊治术后临床表现的改变。不良反应及血清淀粉酶的变化及高淀粉酶血症的分布情况。结果 经ERCP结合EPT等术后患者临床症状显著改善；与B超对照ERCP对胆囊切除术后胆总管残余结石的诊断率显著提高（P＜0．001），对胆总管扩张程度的诊断价值显著优于B超（P＜0．05），并能发现许多B超检查不能发现的胆胰病变；术后主要不良反应表现为出血、高淀粉酶血症，ERCP结合EPT等治疗组高淀粉酶的发生率显著高于单纯ERCP操作组（P＜0．01）。经积极地处理后短期内出血控制，血清淀粉酶多在3日内转为正常。结论 对胆囊切除术后患者，ECRP结合EPT不失为一项非常有价值、安全的诊治措施。     

Endoscopic ultrasonography guided biliary drainage: Summary of consortium meeting,May 7^th , 2011, Chicago

Endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred procedure for biliary or pancreatic drainage in various pancreatico-biliary disorders. With a success rate of more than 90%, ERCP may not achieve biliary or pancreatic drainage in cases with altered anatomy or with tumors obstructing access to the duodenum. In the past those failures were typically managed exclusively by percutaneous approaches by interventional radiologists or surgical intervention. The morbidity associated was significant especially in those patients with advanced malignancy, seeking minimally invasive interventions and improved quality of life. With the advent of biliary drainage via endoscopic ultrasound (EUS) guidance, EUS guided biliary drainage has been used more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that encompasses various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS guided biliary and pancreatic drainage techniques. This diversity has resulted in variations and improvements in EUS Guided biliary and pancreatic drainage; and over the years has led to an extensive nomenclature. The diversity of techniques, nomenclature and recent progress in our intrumentation has led to a dedicated meeting on May 7 th , 2011 during Digestive Disease Week 2011. More than 40 advanced endoscopists from United States, Brazil, Mexico, Venezuela, Colombia, Italy, France, Austria, Germany, Spain, Japan, China, South Korea and India attended this pivotal meeting. The meeting covered improved EUS guided biliary access and drainage procedures, terminology, nomenclature, training and credentialing; as well as emerging devices for EUS guided biliary drainage. This paper summarizes the meeting’s agenda and the conclusions generated by the creation of this consortium group.     

Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without mechanical lithotripsy

AIM： TO introduce a new method： small endoscopic sphincterotomy （ES） combined with endoscopic papillary large balloon dilation （SES ＋ EPLBD） to treat patients with large biliary stones.
METHODS： Retrieval of large biliary stones was performed in 88 patients. Mean stone size was 14 ± 3 mm and mean number of stones was 2.5 ± 3.5. Firstly, ES with a small incision was performed. Next, endoscopic papillary dilation was performed with a large balloon to slowly match the size of the bile duct. Stones were then retrieved from the biliary duct with a balloon and a basket.
RESULTS： Stone retrieval was successful in all cases except one cystic duct stone case without the need to crush large stones. Mean procedure time was 30 ± 5 min. Dilating the papillary orifice with a large balloon made it possible to remove large stones smoothly without crushing them. After dilation with the large balloon, there were some instances of oozing, but no perforations. One instance of post-procedural pancreatitis （1%） occurred.
CONCLUSION： SES ＋ EPLBD was effective for the retrieval of large biliary stones without the use of mechanical lithotripsy.     

Endoscopic ultrasound‐guided pelvic abscess drainage (with video)

Pelvic abscesses present a serious and challenging management problem. Endoscopic ultrasound (EUS)‐guided drainage provides a safe and effective minimally invasive treatment option. The likelihood of a successful outcome is dependent on appropriate patient selection, drainage technique and postoperative management. This review outlines the evidence behind and procedural steps required for EUS‐guided pelvic abscess drainage.