超声内镜与逆行胆管造影诊断胆道梗阻的比较研究

S. Salama, Mona R. Elaziz, Sabry Alfathah, N. Elgendy
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摘要

内镜超声(EUS)是一种诊断程序,继续有更大的临床应用。梗阻性黄疸患者在内镜逆行胰胆管造影(ERCP)前行EUS可降低发病率和死亡率。目的本研究旨在比较EUS和ERCP作为联合或单独手术对30例胆道梗阻患者的诊断准确性。患者与方法2017年1月至2019年12月,我们在开罗爱资哈尔大学附属医院招募了30例梗阻性黄疸患者。所有患者均在同一时段进行了临床检查、实验室检查和腹部超声检查,随后进行了EUS和ERCP检查,并将EUS检查结果与ERCP检查结果进行了比较。结果EUS诊断胆总管结石的准确率为92%,恶性病变的准确率为95%。在胆道系统病理未知的患者中,有47.3%的患者在最初的调查中显示出病理。EUS的总体诊断表现显示,敏感性为90.9,特异性为89,阳性预测值为91.7,阴性预测值为95,准确率为93.5%。对于胆总管结石,ERCP显示13例(43.3%),而EUS显示12例(40%)。对于恶性病变(壶腹肿瘤、胆管癌和胰腺肿瘤),ERCP分别出现4例(13.3%)、7例(23.3%)和3例(10%),而EUS分别出现5例(16.6%)、6例(20%)和5例(16.6%)。并发症发生率为3.3%。结论EUS对梗阻性黄疸病因的诊断具有较高的准确性,ERCP与EUS的诊断结果无统计学差异。这准确地指导了ERCP需求,避免了不必要的ERCP。EUS和ERCP在治疗梗阻性黄疸上是有科学价值的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative study between endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in diagnosis of biliary obstruction
Introduction Endoscopic ultrasound (EUS) is a diagnostic procedure that continues to have greater clinical applications. EUS performed before endoscopic retrograde cholangiopancreatography (ERCP) in patients with obstructive jaundice can reduce morbidity and mortality. Aim This study aimed to compare the diagnostic accuracy of both EUS and ERCP as combined or individual procedures in 30 patients diagnosed with biliary obstruction. Patients and methods From January 2017 to December 2019 in Al Azhar University Hospitals in Cairo, we recruited 30 patients with obstructive jaundice. All the patients underwent clinical examination, laboratory investigations, and abdominal US followed by EUS and ERCP procedures at the same session, and EUS findings were compared with that of ERCP. Results The diagnostic accuracy of EUS was as follows: choledocholithiasis in 92%, and malignant lesions in 95%. EUS showed pathology in 47.3% of patients who had an unknown pathology in biliary system at initial investigations. The overall diagnostic performance of EUS shows that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 90.9, 89, 91.7, 95, and 93.5%, respectively. Regarding common bile duct stone (s), by ERCP, it was present in 13 (43.3%) cases, whereas by EUS, it was present in 12 (40%) cases. Regarding malignant lesions (ampullary tumor, cholangiocarcinoma, and pancreatic tumor), by ERCP, they were present in four (13.3%), seven (23.3%), three (10%) cases, respectively, whereas by EUS, they were present in five (16.6), six (20%), and five (16.6) cases, respectively. The complication rate was 3.3%. Conclusions EUS established high diagnostic accuracy in diagnosing the causes of obstructive jaundice, with no statistically significant difference between ERCP and EUS findings. This accurately guided ERCP need and avoided needless ERCP. EUS and ERCP in a single session for treatment of obstructive jaundice is scientifically valuable.
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