胰腺癌及壶腹周围癌的超声内镜声像特征分析

目的旨在探讨胰腺癌及壶腹周围癌的超声内镜(endoscopic ultrasonography，EUS)声像特征及诊断价值。方法回顾性分析经EUS检查并由病理检查诊断的42例胰腺癌及12例壶腹周围癌，对两类疾病的声像图特征及诊断正确率进行归纳总结。结果EUS对胰腺癌及壶腹周围癌的诊断具有较高的准确性，胰腺癌的诊断准确率为95．2％。壶腹周围癌的诊断准确率为83.3％。EUS对两类肿块的显示率均达100％。胰腺癌中胰腺呈局限性肿大37例(88．1％)，病灶呈低回声33例(78．6％)，伴胆管扩张29例(69．0％)，伴胰管扩张26例(61.9％)：壶腹周围癌中肿块呈低回声的10例(83.3％)，稍强回声的2例(16．7％)，伴肝内外胆管扩张12例(100．0％)，伴胰管扩张7例(58．3％)。结论EUS对胰腺癌及壶腹周围癌均有较高的诊断价值。     

儿童巨大多发胰管结石的超声表现1例

患者男 ,12岁。 2岁时开始上腹部反复疼痛、有时剧痛至今 10余年 ,每次发作时经当地卫生院给予消炎、止痛、解痉治疗症状缓解 ,每次发作持续数日甚至一周。 2 0 0 4年 6月 30日来院就诊 ,体检 :体瘦 ,心肺正常 ,巩膜无黄染 ,血糖、尿糖正常 ,B超检查 :胰腺形态明显增大 ,胰头 34mm× 31mm,胰体 2 4 mm,胰尾 2 0 mm,胰管明显扩张达 10 mm ,于胰头部可见一 31mm× 2 9mm的强回声光团 ,后伴声影。近胰体胰管内可见一 17mm× 12 mm的强回声光团 ,后伴声影 (图 1)箭头 :结石图 1　巨大多发胰管结石声像图　超声提示 :慢性胰腺炎 ,巨大多发胰管结…     

超声诊断主胰管内大结石2例

病例 1,女性 ,32岁。上腹部呈间歇性隐痛 1年 ,其间歇期约 10～ 15天 ,持续 1～ 2天。同时伴有上腹部饱胀不适 ,消化不良及脂肪性腹泻等症状。超声检查发现 ,位于胰腺颈部主胰管内有一大小约 10 cm×1.3cm,呈椭圆形强回声光团伴声影 ,远端主胰管明显扩张约 1.3cm,扩张主胰管内有细弱光点回声。受累胰腺组织变薄、回声增强 (图 1)。超声诊断 :主胰管内结石伴慢性胰腺炎、主胰管梗阻扩张。手术证实 :主胰管内花生米大小坚硬结石伴慢性胰腺炎。图 1　主胰管内大块结石 (箭头所示 )伴主胰管扩张病例 2 ,男性 ,5 0岁。上腹部隐痛伴有饱胀 ,消化不…     

慢性胰腺炎的超声内镜表现与诊断

目的探讨超声内镜在慢性胰腺炎(CP)早期诊断中的应用价值。方法对30例CP患者的胰腺超声内镜表现进行分析,并与对照组30例(胃或食道良性小隆起病变)患者的胰腺超声内镜表现进行对照,筛选出超声内镜诊断CP的敏感指标,并行CP超声内镜分型。结果CP组超声内镜表现:(1)胰头增大24例(24/30),与对照组比较差异有非常显著性(P<0.01);(2)假性囊肿6例(6/30),胰石及多发钙化2例,与对照组比较差异无统计学意义(P>0.05);(3)胰腺实质出现腹背分界不清、点状或线状高回声聚集,管壁回声增强分别为22例(22/30)、23例(23/30)、22例(22/30),特异性为70%、46.7%、40%,与对照组比较差异无统计学意义;(4)胰腺背侧腺体回声不均、主胰管大小异常、胰腺边缘细波纹状或模糊、胰腺大小异常、实质异常回声块特异性高均为80%以上,敏感性亦均为50%,与对照组比较差异有统计学意义(P<0.05)。结论CP超声内镜表现具有多样性,包括胰腺大小、实质、胰管、边缘、异常回声块多种声像表现,其中胰腺背侧腺体回声不均,主胰管大小异常,胰腺边缘细波纹状或模糊,胰腺大小异常,实质异常回声块是5个最敏感的指标。     

超声在胰腺结石诊断中的应用

胰腺结石在临床上相对少见,常规经腹超声诊断胰管结石敏感性较高,术中超声可弥补经腹超声的不足,对胰腺结石进一步准确定性及定位。1998年9月～2005年12月以来采用超声检查出胰腺结石10例,现就其超声声像图分析如下。资料与方法本组胰腺结石患者10例,男性8例,女性2例,年龄20～7     

胰管结石合并胰腺癌的超声诊断

目的探讨胰管结石并胰腺癌的超声图回声改变及超声的诊断作用。方法回顾性总结了12例胰管结石合并胰腺癌患者的临床资料和超声图回声咚变，以及在术前超声诊断漏诊的原因和术中超声诊断的价值。结果术前获得正确诊断10例，2例漏诊患者在术中获得诊断。结论胰腺结石诊断不难，胰腺实质回声增强的强度反映纤维化的程度，在实质回声增强的胰腺中出现回声减弱并有模糊边界是胰腺肿瘤的表现。术中超声检查对胰腺癌的确诊和防止漏诊有重要价值。     

慢性胰腺炎的超声内镜诊断

对３０例慢性胰腺炎作体表腹部超声（ＵＳ）。内镜逆行胰胆管造影（ＥＲＣＰ）和超声内镜（ＥＵＳ）对比检查。对胰管、胰实质回声、胰腺形态、胰石及囊肿等特征的研究表明：①ＥＵＳ能清楚地显示主胰管及其扩张程度、胶管狭窄部位、胰石和囊肿情况，ＥＵＳ对胰石和囊肿的发现率优于ＥＲＣＰ（Ｐ＜０．０１），ＥＵＳ对分枝胰管的显示率低于ＥＲＣＰ（Ｐ＜０．０１）；②ＥＵＳ显示扩张的主胰管与ＵＳ比较无差别（Ｐ＞０．０５），对狭窄的主胰管及分枝胰管的显示率和胰石的显示率均高于ＵＳ（Ｐ＜０．０１），对囊肿的显示二者无差别；③ＥＵＳ能对胰实质回声改变进行分型诊断；④年龄增长和ＥＵＳ非连续切面影响对慢性胰腺炎的诊断；⑤ＥＵＳ与ＵＳ和／或ＥＲＣＰ联合检查可提高慢性胰腺炎的正确诊断率．     

胰腺结石的声像特征

胰腺结石较少见 ,作者自 1991年以来采用 B超诊断仪共检出 9例胰结石患者并追踪观察术后随访 ,现就其声像图特征进行分析 ,报告如下 :本组胰结石患者 9例 ,男性 6例 ,女性 3例 ,年龄 32～ 6 9岁 ,平均 5 2岁。本组无急性腹痛史 ,血、尿淀粉酶正常 ,患糖尿病5例 ,黄疸 6例 ,术前采用 ERCP检查 4例确诊 1例 ,CT检查 9例 ,手术切开取石 7例 ,术中超声 4例。本组胰腺结石均为超声检查首先发现 ,采用西门子 SI- 45 0或小狮王超声诊断仪 ,探头频率 2 .5～ 10 MHz,采用热敏记录仪录像 ,光盘存图 ,录像机录取侧动体位时胰管结石动态征象。结果…     

胆系结石术后肝胆管超声检查的临床价值

目的探讨胆系结石术后肝胆管超声检查的临床价值。方法通过观察肝、胆管及邻周表现，对137例胆系结石术后4d至11年的声像图表现进行分析．并与手术方式对照。结果137例中超声诊断：(1)肝胆管正常57例；(2)肝外胆管扩张26例；(3)残留胆囊管扩张5例，其中1例并肝外胆管扩张，2例并胆管残留结石；(4)胆管积气11例；(5)胆管残留结石或再发结石39例；(6)胆管损伤2例。分别占41．6％，19．0％，3．6％，8．0％，28．5％，1．5％。结论术后超声检查对评价手术效果、发现并发症、指导临床治疗具有重要的临床应用价值。     

超声对胰管蛔虫的诊断及治疗中的价值

目的超声在胰管蛔虫的诊断及治疗中的观察价值。方法对19例胰管蛔虫声像改变，胰管扩张程度、胰实质超声改变观察；明确胰管蛔虫诊断后，经临床安蛔、解痉抗感染等治疗进行观察，了解胰管蛔虫退出时间，退出后胰腺测值，实质回声及胰管的变化。结果19例胰管蛔虫合并肝内胆管蛔虫1例；胆总管蛔虫2例；同时查见肠蛔虫1例，其中1例系肝内胆管蛔虫退到胰管再到钻入肝内胆管。治疗后胰管蛔虫第1d退出2例：第2d退出8例；第3d后退出9例。增大的胰腺、扩张的胰管均在经临床治疗胰管蛔虫退出后恢复正常，结论超声在胰单蛔虫的早期诊断、疗效的评价有肯定的介值。     

超声内镜对胰腺疾病的诊断

本文报告超声内镜（ＥＵＳ）对５０例胰腺癌及３０例慢性胰腺炎的诊断，并与ＵＳ、ＥＲＣＰ和ＣＴ进行了对比研究。结果表明：①ＥＵＳ对胰腺癌的显示率达１００％，诊断正确率达９４％，高于ＵＳ、ＣＴ和ＥＲＣＰ。②ＥＵＳ对胰腺癌术前被膜浸润、胰后方组织浸润、淋巴结转移和门脉浸润的诊断正确率分别为７２％、７４％、７６％和８０％。③ＥＵＳ显示主胰管与ＥＲＣＰ，相近．对胰石和囊肿的发现率优于ＥＲＣＰ。④ＥＵＳ能对胰实质回声改变进行分型诊断。⑤ＥＵＳ与ＵＳ和／或ＥＲＣＰ联合检查可提高慢性胰腺炎的正确诊断率。     

Accurate diagnosis of pancreas divisum by linear-array endoscopic ultrasonography

BACKGROUND AND STUDY AIMS: During linear-array endoscopic ultrasonography (EUS), the main pancreatic duct can be followed continuously from the major papilla into the pancreatic body in most patients. Often, the duct can also be seen crossing a sonographic border between the ventral and dorsal pancreatic anlagen. It was hypothesized that the presence of either feature excludes pancreas divisum, whereas the absence of these features suggests complete pancreas divisum. PATIENTS AND METHODS: Pancreas divisum was sought during all linear-array EUS examinations conducted between July 1999 and June 2003. Charts were reviewed retrospectively, and patients who underwent endoscopic retrograde pancreatography after, but not before, EUS were included in the study. RESULTS: A total of 162 patients had EUS before ERCP. Adequate evaluation of the pancreatic duct was possible in 78 % of the patients. The prevalence of pancreas divisum was 13.6 %. In patients with adequate duct visualization, the sensitivity, specificity, and positive and negative predictive values for EUS were 95 %, 97 %, 86 %, and 99 %, respectively. The overall accuracy of EUS for identifying pancreas divisum was 97 % in this subgroup. CONCLUSION: Adequate EUS evaluation of pancreas divisum was possible in most cases. Linear-array EUS is a promising diagnostic test for pancreas divisum.     

Preliminary experience using endoscopic ultrasonography in the diagnosis of choledocholithiasis.

Twenty patients with symptomatic cholelithiasis and suspected choledocholithiasis were evaluated in an ongoing prospective trial using endoscopic ultrasonography (EUS), standard abdominal ultrasonography (US) and ERCP for the detection of choledocholithiasis prior to laparoscopic cholecystectomy. EUS was used successfully to image the extrahepatic bile duct in all patients. EUS detected three of four proven bile duct stones and correctly identified 16 bile ducts as stone free, thus being more accurate than standard abdominal US. The preliminary results of this ongoing prospective trial and the experience reported by other authors suggest that EUS may be as sensitive as ERCP in the detection of choledocholithiasis.     

Do normal findings 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 238 patients

BACKGROUND AND STUDY AIMS: Biliary endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiography (ERC) are equally accurate for the diagnosis of common bile duct (CBD) stone. The aim of this prospective 1-year follow-up study was to determine whether normal findings at initial EUS obviated the need for ERC. PATIENTS AND METHODS: During a 17-month period, all patients referred for biliary EUS because of suspicion of CBD stone, in whom EUS findings were normal were included in the study. Early (1-month) and late (1-year) follow-up details were obtained by mail or telephone. The clinical course and need for ERC were recorded. RESULTS: 238 patients were enrolled. During follow-up, 59 (25 %) patients underwent cholecystectomy, with (n=31) or without (n=28) cholangiography, and 30 patients underwent ERC (13 %). CBD stone was found in 14 (6 %) patients. Of these 30 patients, ERC was done in 15 cases in the first week after EUS, because of persistent suspicion of a CBD stone which was found in 10 patients. The 15 late ERC procedures (carried out more than 1 week after EUS) revealed only one CBD stone. The negative predictive value of EUS for the diagnosis of CBD stones was 95.4 %. CONCLUSIONS: Patients with suspicion of CBD stones but normal EUS findings have a low risk of needing ERC in a 1-year period.     

Diagnosis of pancreas divisum by endoscopic ultrasonography

BACKGROUND AND STUDY AIMS: During pancreatobiliary imaging by endoscopic ultrasound (EUS) at the authors' institution, it is customary to attempt to obtain the "stack sign", where the bile duct and the pancreatic duct can be seen to run in parallel through the pancreatic head. We suspected that such a view may not be attainable in patients with pancreas divisum because of the short ventral pancreatic duct. The aim of the study was to investigate whether the presence of pancreas divisum could be suspected on the basis of EUS findings. PATIENTS AND METHODS: The stack sign is obtained by positioning the echo endoscope in the long scope position with the transducer in the duodenal bulb. The balloon is then inflated and advanced snugly into the apex of the bulb. From this position, the bile duct (closest to the transducer) and the pancreatic duct can be seen to run in parallel through the pancreatic head. We attempted to obtain a stack sign during EUS examinations of six patients with pancreas divisum. EUS was done in these patients to look for evidence of chronic pancreatitis and the pancreas divisum was confirmed by endoscopic retrograde pancreatography. An attempt to obtain the stack sign was also made in 30 patients who had EUS for pancreatobiliary indications but did not have pancreas divisum. RESULTS: In only two out of six patients with pancreas divisum (33 %) were we able to obtain a stack sign. This was significantly different from the rate of observation of a stack sign in 83.3 % (25/30) of patients who did not have pancreas divisum (P=0.04). Of the two patients with pancreas divisum in whom a stack sign was seen, the ventral duct was markedly dilated (6.6 mm) in one, and the other patient had an unusually large ventral pancreas. CONCLUSIONS: The absence of a stack sign during pancreatobiliary imaging by EUS may suggest the diagnosis of pancreas divisum.     

线阵超声内镜对胆总管结石的诊断价值研究

目的探讨线阵超声内镜对胆总管结石的诊断价值。方法对35例腹部B超发现胆总管扩张,临床怀疑胆总管结石的患者行线阵超声内镜检查,并在3d内再行ERCP及乳头扩约肌切开胆总管取石,以取石的结果计算线阵超声内镜诊断的准确率、灵敏度、特异度、阳性预测值、阴性预测值及Youden指数。结果35例患者中,经线阵超声内镜检查及胆总管取石结石均阳性者22例,阳性率为62.8％（22／35）,均阴性者12例。线阵超声内镜检查有1例假阳性,无假阴性。与胆总管取石比较,线阵超声内镜诊断胆总管结石的准确率为97．1％,灵敏度为100％,特异度为92．3％,阳性预测值为95．6％,阴性预测值100％,Youden指数为92．3％,且未出现并发症。结论线阵超声内镜检查是诊断胆总管结石安全而可靠的方法。     

Endoscopic sonography in the diagnosis of gallbladder wall lesions in patients with gallstones

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of endoscopic sonography (EUS) in the detection of gallbladder wall lesions in patients with and without gallstones. METHODS: We retrospectively reviewed the medical records, sonograms, and sonographic reports of 62 patients who underwent cholecystectomy for gallbladder wall lesions evaluated by EUS. We assessed the accuracy of EUS in diagnosing gallbladder wall lesions in the presence or absence of gallstones and on the basis of the size and number of stones and the size of the gallbladder wall lesions. We also evaluated the effect of acoustic shadowing. The EUS results were compared with the histopathologic results. RESULTS: EUS correctly diagnosed the gallbladder wall lesions in 17 (71%) of 24 patients with gallstones and in 34 (89%) of 38 patients without gallstones. The diagnostic accuracy of EUS was 86% in patients with gallbladder wall lesions smaller than 20 mm and 79% in patients with gallbladder wall lesions 20 mm or larger. The diagnostic accuracy was 75% in patients with gallstones smaller than 5 mm and 67% in patients with stones 5 mm or larger. The accuracy was 67% in patients with 1-5 stones and 83% in patients with 6 or more stones. None of these differences was statistically significant. Acoustic shadowing did not affect the diagnostic accuracy of EUS. CONCLUSIONS: The diagnostic accuracy of EUS for gallbladder wall lesions is not affected by the presence of gallstones. However, better diagnostic criteria must be established based on larger studies, and technical refinements of the equipment are needed to increase the accuracy of EUS in the diagnosis of gallbladder wall lesions.     

Accuracy of linear endoscopic ultrasonography in the evaluation of patients with suspected common bile duct stones

BACKGROUND AND STUDY AIMS: Endoscopic ultrasonography (EUS) with radial scanning is an efficient diagnostic tool where there is suspicion of common bile duct (CBD) stones. Little is known about the use of linear EUS in this condition. The aim of this study was to evaluate the diagnostic efficiency of linear EUS in a large group of patients suspected to have bile duct stones, using endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and exploration of the CBD using a Dormia basket, or surgical choledochotomy with choledochoscopy, as diagnostic "gold standards." PATIENTS AND METHODS: 134 patients with clinical suspicion of CBD stones were included in the study and prospectively evaluated, using EUS, and ERCP with endoscopic sphincterotomy (127 patients), or choledochotomy with choledochoscopy where ERCP was unsuccessful (seven patients). EUS was done before ERCP using an echo endoscope (Pentax FG 32 UA; 5 - 7.5 MHz) and Hitachi EUB 405 ultrasound machine. ERCP was done using the TFJ 100 or TJ 20 Olympus duodenoscope. ERCP was carried out within a mean of 2 days after EUS. The longest time between EUS and ERCP was 3 days. The examiners were blinded to the results of the other method used. RESULTS: CBD stones were found in 91 (68 %) patients at ERCP with ES or at surgery. The correct diagnosis was established by EUS in 85 patients. The remaining 43 patients without CBD stones were correctly diagnosed in 41 cases by means of EUS, giving an accuracy of 94 %, sensitivity of 93 %, specificity of 93 %, a positive predictive value of 98 %, a negative predictive value of 87 %, and a Youden's index of 89 %. CONCLUSIONS: Linear EUS is a fairly reliable method for the evaluation of patients with high suspicion for CBD stones. The usefulness of linear EUS in the evaluation of patients with low or moderate suspicion for CBD stones warrants further study.     

Diagnosis and fine needle aspiration of intraductal papillary mucinous tumor by endoscopic ultrasound

A recently established clinical entity, intraductal papillary mucinous tumor (IPMT) of the pancreas embraces a spectrum of pathology ranging from benign to malignant disease. IPMT must be differentiated from other cystic neoplasms of the pancreas, as well as inflammatory cystic lesions. As the pancreas lies in close proximity to the gastric and duodenal walls, endoscopic ultrasonography (EUS) is ideally suited for imaging the pancreas. Additionally, EUS facilitates fine needle aspiration of pancreatic cysts and/or a dilated pancreatic duct for cytologic and tumor marker analysis. This article presents a brief history of IPMT, differential diagnosis, current imaging modalities, findings of cytologic and tumor marker analysis, prognosis, and treatment strategy. Special emphasis is dedicated to the role of EUS, as well as EUS with fine needle aspiration.