胆总管结石的内镜超声诊断

胆总管结石 (ｃｏｍｍｏｎｂｉｌｅｄｕｃｔｓｔｏｎｅ,ＣＢＤＳ)由于解剖部位特殊 ,常不易用常规方法诊断。我们为 42例经反复多次上腹部Ｂ型超声波检查 (ｔｒａｎｓａｂｄｏｍｉｎａｌｕｌｔｒａｓｏｎｏｇｒａｐｈｙ ,ＵＳ)未能发现ＣＢＤＳ的患者进行了内镜超声检查技术 (ｅｎｄｏｓｃｏｐｉｃｕｌｔｒａｓｏｎｏｇｒａｐｈｙ ,ＥＵＳ) ,并同ＥＲＣＰ和手术结果对比研究。现将ＥＵＳ在ＣＢＤＳ患者诊断中的应用体会作一分析讨论。材料和方法一、研究对象42例患者均系 1998年 11月至 2 0 0 0年 3月期间我院门诊和住院患者。男 2 2例 ,女 …     

超声内镜对食管隆起病灶的诊断价值

超声内镜（ｅｎｄｏｓｃｏｐｉｃｕｌｔｒａｓｏｎｏｇｒａｐｈｙ，ＥＵＳ）问世以来，对食管隆起性病灶的诊断水平有了较大提高，本文就ＥＵＳ、胃镜、钡餐造影诊断食管隆起性质灶作一比较研究。一、资料和方法１９９２年４月至１９９５年２月，对由胃镜、钡餐造影和ＣＴ等影像检查发现的４６例食管隆起性病灶进行了ＥＵＳ检查。ＥＵＳ采用ＯｌｙｍｐｕｓＧＦ－ＵＭ３型超声内镜，探头频率７．５ｍＨｚ与１２ｍＨｚ可调。ＥＵＳ采用水囊直接接触法显示，全部病例均行两种频率对照显示，并行多倍图像放大处理；手术患者均行标本水浸法ＥＵＳ…     

胆道癌肿的DSA诊断和介入性治疗

目的研究数字减影血管造影（ＤＳＡ）对胆道癌肿的诊断及其介入性治疗的临床意义．方法胆道癌肿５７例，男４５例，女１２例．年龄３５岁～６８岁，平均５５１岁．均施行ＤＳＡ诊断，并对其中５２例施行经肝动脉灌注化疗（应用ＭＭＣ、ＥＡＤＭ与５ＦＵ）加栓塞（应用４０％碘化油与明胶海绵）治疗．结果ＤＳＡ诊断均经手术及病理证实，诊断符合率为８４２％，治疗有效率为７５０％．结论ＤＳＡ对胆道癌肿有特殊的诊断价值，对病程了解、预后估计与治疗方案的选择有很大帮助，并可提高化疗疗效．     

内镜超声检查应用于直肠癌术前分期诊断

自１９９３年１～１２月，应用术前内镜超声检查（ＥＵＳ）对３０例直肠癌患者进行Ｄｕｋｅ分期。扫描时采用水充盈法、气囊法或二者结合的方法。ＥＵＳ诊断癌的浸润深度与病理诊断的符合率为８６．７％（２６／３０）；ＥＵＳ诊断淋巴结转移与病理诊断的符合率为７６．７％（２３／３０）；根据癌浸润深度及淋巴结有无转移进行的Ｄｕｋｅ分期，正确率达７６．７％（２３／３０）。ＥＵＳ对决定直肠癌手术治疗的方式有重要意义，将成为术前重要的检查手段。     

磁共振胆胰管成像对老年性胆总管扩张患者诊断价值

目的老年性胆总管扩张患者磁共振胆胰管成像（magnetic resonance cholangiopancreatography，MRCP）的诊断和鉴别诊断价值评估。方法回顾性分析197例老年性胆总管扩张患者MRCP检查及临床诊断与治疗结果进行比较。结果MRCP诊断为胆总管下端结石68例，急性胆囊炎，胆囊结石伴胆总管扩张57例，胆囊切除术后改变38例，胆囊颈管结石22例，胆道系统肿瘤7例，胰腺占位性病变5例，诊断符合率99．5％结论MRCP在老年性胆总管扩张的病因诊断和鉴别诊断中有重要价值。     

B超检查在肾结核诊断上的应用

目的 探讨Ｂ超检查在肾结核诊断上的应用价值。方法 收集我院１９８３年后以Ａｌｏｋａ ＳＳＤ－２５６型和ＴＯＳＨＩＢＡ ＳＡＬ－３８Ｂ型超声仪诊断肾结核３８例,其中经手术病理证实２３例,Ｘ线静脉肾盏造影证实９例,尿杆菌检查阳性证实６例。结果Ｂ超诊断符合率为８６．８％,Ｘ线静脉肾盂造影诊断符合率为２３．７％,尿抗酸杆菌检查诊断符合率为１５．８％。结论 Ｂ超诊断肾结核符合率高,简便易行、无创伤,如结合     

ERCP对肝外胆管癌的诊断价值

目的对手术病理证实的３１例肝外胆管癌进行回顾性分析．方法３１例患者均行胰胆管造影，并和Ｂ超及ＣＴ检查进行对照．结果上段胆管癌１６例，下段胆管癌１３例，中上段胆管癌２例．１例为横纹肌肉瘤，２例为腺瘤癌变，其余均为腺癌．ＥＲＣＰ成功２８例（９０３％），Ｂ超诊断符合率为８０７％，而ＣＴ显示梗阻８５０％，能明确病因者仅７００％．结论ＥＲＣＰ在早期诊断肝外胆管癌方面明显优于Ｂ超及ＣＴ检查，并能清晰地显示胆道系统的全貌，对治疗及手术方案选择有重要价值．     

内镜下活组织和刷细胞学检查对94例恶性胆总管狭窄患者的诊断

内镜下活组织和刷细胞学检查对９４例恶性胆总管狭窄患者的诊断肖小炜Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｃｏｍｍｏｎｂｉｌｅｄｕｃｔｎｅｏｐｌａｓｍｓ／ｄｉａｇｎｏｓｉｓ；ｂｉｏｐｓｙ；ｃｙｔｏｄｉａｇｎｏｓｉｓ；主题词胆总管肿瘤／诊断；活组织检查；细胞诊断...     

超声内镜在胃癌食癌术前诊断中的应用

为探讨超声内镜（ＥＵＳ）在胃癌，食管癌术前诊断中的应用价值，对３６例胃癌，１５例食管癌术前进行ＥＵＳ检查，将其结果与术后病理对照，根据肿瘤新ＴＮＭ分期，ＥＵＳ对胃癌，食管癌术前Ｔ分期判断的准确率分别为８１％，８７％，对Ｎ分期判断的准确率分别为７２％，８０％，对胃癌，食管癌术前可切除性分期（Ｒ０）判断的准确率分别为９５％，９３％，提示ＥＵＳ能较准确地判断胃癌，食管癌的分期，能准确地判断早期癌，为早癌     

内镜超声检查对胆总管结石的诊断价值

目的 探讨内镜超声检查(EUS)对胆总管结石的诊断价值。方法 回顾性总结近3年来术前B超、CT等检查未能确定胆总管结石而行EUS并经内镜乳头切开术(EST)取石或手术治疗证实者资料，共45例。结果 45例中，EUS诊断胆总管结石43例，另2例诊断胆管轻度扩张，经EST取出高位胆管小结石；EUS诊断胆总管结石者中，2例分别经EST和手术(合并胆囊结石)，胆管内未见结石。其敏感度为95％，阳性预测值为95％。结石最大1、2cm，最小0．3cm，其中≤0．5cm者26例，45例中B超诊断4例可疑胆总管末端结石，2例怀疑壶腹周围占位性病变。CT诊断3例可疑胆总管结石，1例怀疑壶腹占位性病变。结论 EUS在诊断胆总管结石方面，不论胆管是否扩张，不论结石大小，都明显优于B超和CT，尤其是小结石，可与ERCP相媲美，而比ERCP更少侵袭性，更安全。     

超声内镜与B超诊断胰腺疾病的对比分析

目的 探讨超声内镜(EUS)和B超对胰腺疾病的诊断价值。方法 对1999年6月至2001年6月期间123例胰腺疾病患行EUS检查并与体表B超检查结果进行比较。结果 63例胰腺癌、45例胰腺炎和11例其它胰腺疾病患经EUS确诊。38例胰腺癌，28例胰腺炎和5例其它胰腺疾病经US确诊。EUS诊断胰腺疾病的敏感性与准确性均明显高于B超，EUS与B超诊断符合率分别为96．7％(119／123)与56．9％(70／123)(P＜0．01)。结论 EUS在胰腺疾病诊断中有较高的特异性和准确性，与B超联合应用有助于胰腺疾病的诊断。     

超声内镜与CT仿真内镜对上消化道隆起样病变的诊断价值

目的 研究超声内镜(EUS)与CT仿真内镜(CTVE)对上消化道隆起样病变的诊断价值。方法 48例经胃镜检查发现有上消化道隆起样病变的患者(食管癌、胃癌、息肉等病例除外)，行CTVE和EUS检查，除9例检查发现为正常脏器外压、2例食管静脉瘤而密切随访观察外，其余均经手术或活检获取病理确诊。将以上三种方法诊断结果与病理结果进行比较。结果 胃镜、EUS、CTVE对上消化道隆起样病变的诊断准确率分别为16．7％、89．6％、66．7％，EUS、CTVE与胃镜检查结果差异有显著性(P＜0．001)；EUS、CTVE两者之间比较差异有显著性(P＜0．05)，EUS优于CTVE；EUS、CTVE对上述疾病的诊断的敏感性、特异性分别为89．7％、88．9％和66．7％、66.7％。结论 EUS和CTVE作为新兴的检查手段在对上消化道隆起样病变的诊断中有较高的临床实用价值，且两者有较强的互补性，可作为胃镜较难诊断的上消化道隆起样病变的确诊方法之一。     

内镜超声检查对胆总管无扩张伴可疑胆总管结石的诊断价值

目的 探讨胆总管无扩张伴可疑胆总管结石患者（CBDS）行超声内镜检查（EUS）的价值.方法 对33例经多次腹部B超检查诊断胆囊结石,胆总管直径〈8 mm,未发现CBDS但有急性胰腺炎、阻塞性黄疸或反复胆绞痛等病史之一的患者行EUS,并与手术或ERCP结果进行比较.结果 33例患者行EUS,20例发现CBDS.经进一步手术或ERCP,该20例患者中有16例证实有CBDS.EUS对本组病例CBDS诊断的灵敏度为100%,特异度为76.5%,阳性预测价值为80%,阴性预测价值为100%.结论 对胆总管无扩张但有可疑CBDS者行EUS检查有较高的临床价值.     

The clinical impact and cost implication of endoscopic ultrasound on use of endoscopic retrograde cholangiopancreatography in a Canadian university hospital.

BACKGROUND: Endoscopic ultrasound (EUS) is a safe alternative to endoscopic retrograde cholangiopancreatography (ERCP) for diagnostic biliary imaging in choledocholithiasis. Evidence linking a decline in diagnostic ERCP with the introduction of EUS in clinical practice is limited. OBJECTIVE: To assess the clinical impact and cost implications of a new EUS program on diagnostic ERCP at a tertiary referral centre. PATIENTS AND METHODS: A retrospective review was performed of data collected during the first year of EUS at the University of Alberta Hospital (Edmonton, Alberta). Patients were referred for ERCP because of suspicion of choledocholithiasis based on clinical, biochemical and/or radiological parameters. If they were assessed to have an intermediate probability of choledocholithiasis, EUS was performed first. ERCP was performed if EUS suggested choledocholithiasis, whereas patients were clinically followed for six months if their EUS was normal. Cost data were assessed from a third-party payer perspective, and cost savings were expressed in terms of ERCP procedures avoided. RESULTS: Over 12 months, 90 patients (63 female, mean age 58 years) underwent EUS for suspected biliary tract abnormalities. EUS suggested choledocholithiasis in 20 patients (22%), and this was confirmed by ERCP in 17 of the 20 patients. EUS was normal in 69 patients, and none underwent a subsequent ERCP during a six-month follow-up period. One patient had pancreatic cancer and did not undergo ERCP. The sensitivity and specificity of EUS for choledocholithiasis were 100% and 96%, respectively. A total of 440 ERCP procedures were performed over the same 12-month period, suggesting that EUS resulted in a 14% reduction in ERCP procedures (70 of 510). There were no complications of EUS. The cost of 90 EUS procedures was $42,840, compared with $108,854 for 70 ERCP procedures. The cost savings for the first year were $66,014. CONCLUSION: EUS appears to be accurate, safe and cost effective in diagnostic biliary imaging for suspected choledocholithiasis. The impact of EUS is the avoidance of ERCP in selected cases, thereby preventing the risk of complications. Diagnostic ERCP should not be performed in centres and regions with physicians trained in EUS.     

超声内镜诊断胰腺内分泌肿瘤的价值

目的探讨超声内镜诊断胰腺内分泌肿瘤的价值．方法胰腺内分泌肿瘤患者１０例,进行了超声内镜、血管造影、ＭＲＩ,ＣＴ及超声波检查．结果超声内镜对胰腺内分泌肿瘤的诊断率为９２３％,其中肿瘤直径在２ｃｍ以下的诊断率为８７５％,肿瘤轮廓清晰,边缘整,内部回声呈强回声、低回声、等回声和混合性回声;超声波的诊断率为４６２％;ＣＴ平扫和增强扫描的诊断率分别为３０７％和４６２％;ＭＲＩＴ１呈低信号、Ｔ２呈高信号,诊断率为７２７％;血管造影的诊断率为８４６％．结论超声内镜对胰腺内分泌肿瘤的定位诊断和定性诊断优于其他影像学检查,特别是对胰腺小肿瘤的诊断,更显示出它的价值．     

Diagnostic value of endoscopic ultrasonography for gastrointestinal leiomyoma

AIM: To investigate the clinical pathologic features of gastrointestinal leiomyoma and the diagnostic value of endoscopic ultrasonography (EUS) on gastrointestinal leiomyoma. METHODS: A total of 106 patients with gastrointestinal leiomyoma diagnosed with EUS were studied. The location, size and layer origin of gastric and esophageal leiomyomas were analyzed and compared. The histological diagnosis of the resected specimens by endoscopy or surgery in some patients was compared with their results of EUS. RESULTS: The majority of esophageal leiomyomas were located in the middle and lower part of the esophagus and their size was smaller than 1.0 cm, and 62.1 % of esophageal leiomyomas originated from the muscularis mucosae. Most of the gastric leiomyomas were located in the body and fundus of the stomach with a size of 1-2 cm. Almost all gastric leiomyomas (94.2 %) originated from the muscularis propria. The postoperative histological results of 54 patients treated by endoscopic resection or surgical excision were completely consistent with the preoperative diagnosis of EUS, and the diagnostic specificity of EUS to gastrointestinal leiomyoma was 94.7 %. CONCLUSION: The size and layer origin of esophageal leiomyomas are different from that of gastric leiomyomas. Being safe and accurate, EUS is the best method not only for gastrointestinal leiomyoma diagnosis but also for the follow-up of patients.     

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(MR1)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,与手术病理比较,EUS诊断正确率为92%,CT/MRI为76.9%(P＞0.05),B超为41.6%(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.     

Endoscopic ultrasonography versus cholangiography for the diagnosis of choledocholithiasis

Background: Choledocholithiasis is a major source of morbidity among patients undergoing cholecystectomy for symptomatic gallstones. There is no consensus on the best approach to diagnosing bile duct stones. We compared the safety, accuracy, diagnostic yield, and cost of EUS- and ERCP-based approaches. Methods: Sixty-four consecutive pre- and post-cholecystectomy patients referred for endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis were prospectively evaluated in a blinded fashion. All were stratified into risk groups using predefined criteria. Endoscopic ultrasonography (EUS) and ERCP were sequentially performed by two endoscopists. Results: The success rates of EUS and ERCP were 98% and 94%, respectively. The accuracy of EUS for diagnosing choledocholithiasis was 94%. EUS provided an additional or alternative diagnosis to bile duct stones in 21% of patients. The complication rate of EUS was significantly lower than diagnostic ERCP. An EUS-based strategy costs less than diagnostic ERCP in patients with low, moderate, or intermediate risk. Conclusions: EUS is comparably accurate, but safer and less costly than ERCP for evaluating patients with suspected choledocholithiasis. It is useful in patients with an increased risk of having common bile duct stones based on clinical criteria and those with contraindications for or prior unsuccessful ERCP. EUS may enable selective performance of ERCP and improve the cost-effectiveness of diagnosing choledocholithiasis. (Gastrointest Endosc 1998;47:439-48.)     

Prospective assessment of the utility of EUS in the evaluation of gallstone pancreatitis

BACKGROUND: The ability to identify common bile duct stones by noninvasive means in patients with acute biliary pancreatitis is limited. The aim of this study was to prospectively evaluate the ability of endosonography (EUS) to identify cholelithiasis and choledocholithiasis and predict disease severity in patients with nonalcoholic pancreatitis. METHODS: EUS was performed immediately before endoscopic retrograde cholangiopancreatography (ERCP) by separate blinded examiners within 72 hours of admission. Gallbladder findings were compared between EUS and transabdominal ultrasonography (US). Using endoscopic extraction of a bile duct stone as the reference standard for choledocholithiasis, the diagnostic yield of EUS was compared with transabdominal US and ERCP. Features identified during endosonographic imaging of the pancreas were correlated with length of hospitalization. RESULTS: Thirty-six patients were studied. EUS and transabdominal US were concordant in their interpretation of gallbladder findings in 92% of patients. The sensitivity of transabdominal US, EUS, and ERCP for identifying choledocholithiasis was 50%, 91%, and 92% and the accuracy was 83%, 97%, and 89%, respectively. Length of hospital stay was longer in patients with peripancreatic fluid (9.2 vs. 5.7 days, p < 0.1) and shorter in patients with coarse echo texture (2.6 vs. 7.2 days, p < 0.05) demonstrated on EUS. CONCLUSIONS: EUS can reliably identify cholelithiasis and is more sensitive than transabdominal US in detecting choledocholithiasis in patients with biliary pancreatitis. EUS may be used early in the management of patients with acute pancreatitis to select those who would benefit from endoscopic stone extraction. The utility of EUS for predicting pancreatitis severity requires further investigation.     

Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography

AIM: To elucidate the role of contrast-enhanced endoscopic ultrasonography (CE-EUS) in the diagnosis of branch duct intraductal papillary mucinous neoplasm (BD-IPMN).METHODS: A total of 50 patients diagnosed with BD-IPMN by computed tomography (CT) and endoscopic ultrasonography (EUS) at our institute were included in this study. CE-EUS was performed when mural lesions were detected by EUS. The diagnostic accuracy for identifying mural nodules (MNs) was evaluated by CT, EUS, and EUS combined with CE-EUS. In the patients who underwent resection, the accuracy of measuring MN height with each imaging modality was compared. The cut-off values to diagnose malignant BD-IPMNs based on MN height for each imaging modality were determined using receiver operating characteristic curve analysis.RESULTS: Fifteen patients were diagnosed with BD-IPMN with MNs and underwent resection. The remaining 35 patients were diagnosed with BD-IPMN without MNs and underwent follow-up monitoring. The pathological findings revealed 14 cases with MNs and one case without. The accuracy for diagnosing MNs was 92% using CT and 72% using EUS; the diagnostic accuracy increased to 98% when EUS and CE-EUS were combined. The accuracy for measuring MN height significantly improved when using CE-EUS compared with using CT or EUS (median measurement error value, CT: 3.3 mm vs CE-EUS: 0.6 mm, P < 0.05; EUS: 2.1 mm vs CE-EUS: 0.6 mm, P < 0.01). A cut-off value of 8.8 mm for MN height as measured by CE-EUS improved the accuracy of diagnosing malignant BD-IPMN to 93%.CONCLUSION: Using CE-EUS to measure MN height provides a highly accurate method for differentiating benign from malignant BD-IPMN.