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。

The diagnostic value of ERCP combined with intraductal ultrasonography for bile duct stricture dis-eases

Objective To study the diagnostic value of endoscopic retrograde cholangiopancreatog- raphy （ERCP） combined with intraductal uhrasonography （IDUS） for bile duct stricture diseases. Methods The results of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography, intraductal ultrasonography, bile duct brushing cytology, the liquid-based cytology and the histopathologieal examination were analyzed retrospectively. The final diagnosis was made based on clinical data, histopathology and follow-up results（ t〉4 months）. Results Twenty-one patients were diagnosed as having malignant biliary diseases, including 9 biliary tract carcinoma, 4 duodenal papilla carcinoma, 4 pancreatic cancer infiltrated common bile duct ,4 cancer of the liver infiltrated common bile duct; 15 were diagnosed as having benign biliary diseases, including 9 bile duct stones, 4 liver fluke disease, l bile duct inflammatory stenosis, 1 bile duct stricture caused by external compression. The accuracy rate of the EUS, ERCP, IDUS and ERCP ＋ IDUS in the differential diagnosis of the bile duct stricture disease were 77. 8%, 88. 9%, 91.7% and 94. 4% , respectively. The accuracy rates of IDUS, ERCP, ERCP combined with IDUS were significantly higher than that of EUS （ P 〈 0.05 ）. The sensitivity, specificity, positive predictive value and negative predictive value of ERCP combined with IDUS were 95.2%, 93.3%, 95. 2% and 93.3% respectively which were higher than those of EUS, ERCP and IDUS. After the bile duct brushing cytology and the liquid-basedcytology or histopathological examination, 19 patients were diagnosed as having malignant biliary diseases, 17 were benign biliary diseases. The sensitivity, specificity and accuracy of the procedures for malignant bile duct stricture disease were 90. 5%, 100. 0% , 94. 4% respectively. Condttsion ERCP combined with IDUS can improve the diagnostic accuracy. The diagnostic positive rate will be higher with the help of ER- CP, IDUS and targeted brush.