Preoperative diagnosis of bile duct strictures--comparison of intraductal ultrasonography with conventional endosonography.
Preoperative diagnosis of bile duct strictures--comparison of intraductal ultrasonography with conventional endosonography.
复制标题
胆管狭窄的术前诊断——导管内超声检查与常规超声内检查的比较
DOI：
10.1080/003655200750024579
复制
发表时间：
2000
影响因子：
1.9
通讯作者：
W. Domschke
中科院分区：
文献类型：
--
作者：
J. Menzel;C. Poremba;K. Dietl;W. Domschke
背景
比较导管内超声(IDUS)和内窥镜超声(EUS)在诊断胆道梗阻和预测手术可切除性方面的准确性。
方法
对56例胆道梗阻患者进行了术前常规EUS和IDUS检查。在内窥镜逆行胰胆管造影术(ERCP)中，超声微探头通过十二指肠镜工作通道插入胆管系统。常规的腔内超声检查是在标准技术下使用回声内窥镜进行的。对腔内超声图像进行前瞻性回顾，并与术中所见和切除标本分析进行比较。
结果
在准确性(89.1%；EUS，75.6%；P<；0.002)、敏感性(IDU，91.1%；EUS，75.7%；P<；0.002)、特异性(IDUS，80%；EUS，75%；NS)和T分期(IDU，77.7%；EUS，54.1%；P<；0.001)方面，IDUS优于EUS。在胆管癌中，IDUS对淋巴结分期的准确率(60%)与EUS(62.5%)相当。然而，在胰腺癌中，注射超声的淋巴结分期(13.3%)明显低于超声(69.2%)(P<；0.002)。腔内超声可以预测胆管肿瘤的潜在可切除性(IDUS，81.8%；EUS，75.6%；P<；0.002)。
结论
IDUS对恶性胆管狭窄的术前诊断和T分期准确，但不适用于淋巴结分期。在ERCP中使用微型探头的注射超声在胆道梗阻的显示、诊断的准确性和敏感性以及对外科肿瘤可切除性的预测方面均优于传统的EUS。此外，与EUS不同的是，在ERCP过程中，可以方便地在同一会话中执行IDU。
BACKGROUND
The accuracy of intraductal ultrasonography (IDUS) and endoscopic ultrasonography (EUS) were compared in diagnosing biliary obstruction and in predicting surgical resectability.
METHODS
Fifty-six patients with biliary obstruction were investigated preoperatively with both conventional EUS and IDUS. The ultrasonographic miniprobe was inserted into the bile duct system through the working channel of the duodenoscope during endoscopic retrograde cholangiopancreatography (ERCP). Conventional endosonography was performed with echoendoscopes in a standard technique. Images of endoluminal ultrasonography were prospectively reviewed and compared with intraoperative findings and resection specimen analyses.
RESULTS
IDUS exceeded EUS in terms of accuracy (IDUS, 89.1%; EUS, 75.6%; P < 0.002), sensitivity (IDUS, 91.1%; EUS, 75.7%; P < 0.002), specificity (IDUS, 80%; EUS, 75%; NS), and T-staging (IDUS, 77.7%; EUS, 54.1%; P < 0.001). In bile duct carcinomas the accuracy rate for lymph node staging using IDUS (60%) is comparable with that using EUS (62.5%). In pancreatic carcinomas, however, lymph node staging using IDUS (13.3%) is significantly (P < 0.002) inferior to EUS (69.2%). Endoluminal ultrasonography may predict the potential resectability of bile duct tumors (IDUS, 81.8%; EUS, 75.6%; P < 0.002).
CONCLUSIONS
IDUS proved to be accurate in preoperative diagnosing and T-staging of malignant biliary strictures, whereas it is not suitable for lymph node staging. IDUS using miniprobes during ERCP exceeds conventional EUS in terms of depiction of bile duct obstruction, diagnostic accuracy, and sensitivity and in the prediction of surgical tumor resectability. Additionally, different to EUS, IDUS can conveniently be performed during ERCP in one and the same session.