EUS联合ERCP诊治不明原因肝外胆管阻塞性黄疸分析

摘要

目的：分析内镜超声(EUS)联合内镜逆行胰胆管造影(ERCP)诊治不明原因肝外胆管阻塞性黄疸的效果。方法选择2012年5月~2013年11月本院经B超、CT和MRCP检查诊断为不明原因肝外胆管阻塞性黄疸患者60例，对其采用EUS、ERCP检查，观察检查结果。结果60例患者中采用内镜超声(EUS)检查诊断胆道微结石患者54例，采用ERCP结合乳头扩张术或EST结合胆道取石术证实胆道微结石55例；5例为胆总管下端炎性狭窄并行胆道内支架植入术。内镜超声(EUS)与内镜逆行胰胆管造影(ERCP)及EUS联合ERCP检查结果准确性有差异，但不明显，差异不具有统计学意义(P>0.05)。结论肝外胆管阻塞的主要原因是胆道微结石，采用EUS、ERCP检查不明原因肝外胆管阻塞性黄疸准确性高、安全，如果两者联合准确性更高，具有较高的临床应用价值。%Objective To analyze the effect of EUS(endoscopic ultrasonography)combined with ERCP(endoscopic retrograde cholangiopancreatography)in the diagnosis and treatment of extrahepatic biliary obstruction icterus caused by unknown causes. Methods 60 patients with extrahepatic biliary obstruction icterus caused by unknown causes who receive B ultrasound, CT and MRCP examination in our hospital from May 2012 to Nov 2013 were selected as the study objects, EUS and ERCP were adopted in patients,then observe the results. Results In the 60 patients, 54 patients were diagnosed with biliary microlithiasis by EUS, after adopting ERCP combined with papillary dilatation or EST combined with biliarystone removal,it verified that 55 patients had biliary microlithiasis,5 patients had inflammatory stenosis in lower common bile duct and adopted stent implantation in biliary tract.Accuracy differences of examination. Results Between EUS, ERCP and combined EUS and ERCP were not significant,without statistical significance (P>0.05). Conclusion The main course of extrahepatic biliary obstruction icterus is biliary microlithiasis,the accuracy and and safety of EUS and ERCP in the exmanination of unknown causes for extrahepatic biliary obstruction icterus are high,and the clinical application value of combined EUS and ERCP is higher.