经内镜逆行胰胆管造影途经下腔内超声及细胞刷对胆管恶性狭窄的早期诊断价值

摘要

目的 探讨经内镜逆行胰胆管造影(ERCP)途经下腔内超声(IDUS)及细胞刷对胆管恶性狭窄的早期诊断价值.方法 对2011年1月至2012年1月72例临床可疑恶性胆管狭窄的患者先行ERCP,接着行术中IDUS,再行胆道细胞刷刷检送病理.对单一检测以及联合检测对胆管恶性狭窄早期诊断的敏感性、特异性、阳性预测值、阴性预测值及准确性作对比分析.结果 与ERCP比较,IDUS在敏感性,阳、阴性预测值及准确性上均有明显优势(P＜0.05),而细胞刷在敏感性、特异性、阳性预测值及准确性上优势明显(P＜0.05)；IDUS与细胞刷相比,各值差异无统计学意义(P＞0.05).ERCP+IDUS与ERCP+细胞刷相比,各值差异无统计学意义(P＞0.05)；ERCP联合IDUS及细胞刷在敏感性、阴性预测值及准确性上优势明显(P＜0.05),在特异性及阳性预测值上差异无统计学意义(P＞0.05).结论 ERCP过程中联合IDUS及细胞刷有助于胆管恶性狭窄的早期诊断.%Objective To evaluate the value of intraductal ultrasonography (US) (IDUS) or cytology brushing during endoscopic retrograde cholangiopancreatography (ERCP) in the early diagnosis of malignant biliary stricture.Method 72 patients suspected malignant biliary stenosis were performed ERCP firstly,then IDUS and finally cytology brushing from January 2011 to January 2012,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of all aboved ways were evaluated and compared.Results Compared with ERCP,IDUS had obvious advan tages(P＜0.05) in the sensitivity,positive and negative predictive value and accuracy,and cytology brushing had obvious advantages(P＜0.05) in the sensitivity,specificity,positive predictive value and accuracy (P＜0.05).There were not statistical significance in all paremeters between IDUS and cytology brushing or between ERCP+IDUS and ERCP+cytology brushing(P＞0.05).But there were obvious statistical significance in the sensitivity,negative predictive value and accuracy between ERCP+ IDUS+ cytology brushing and ERCP + IDUS or ERCP + cytology brushing (P＜ 0.05).Conclusion ERCP combined with IDUS and cytology brushing helps diagnose the malignant biliary stricture earlier.