摘要：
目的 评估超声内镜(EUS)在胆胰管扩张病变诊断中的价值.方法 对42例体外超声(US)不能确诊病变的胆胰管扩张患者施行EUS、CT、MRI检查,并比较各种检查法对病变的诊断率.结果 EUS诊断壶腹周围肿瘤18例,漏诊胰腺癌、胆管下段癌各1例;诊断3例慢性胰腺炎,其中1例最后确诊为自身免疫性胰腺炎;诊断1例胰腺段胆总管囊肿.10例胆总管末端结石及1例胰管开口结石EUS100％诊断.EUS诊断4例缩窄性十二指肠乳头炎(3例伴十二指肠乳头旁憩室,1例伴胰腺分裂症)、2例胆总管下段炎性狭窄;漏诊1例Oddi括约肌功能障碍(SOD 1型).US、EUS、CT、MRI的病变诊断率分别为7.1％、92.9％、33.3％、31.0％.20例确诊壶腹周围肿瘤患者US、EUS、CT、MRI的病变诊断率分别为10.0％、90.0％、35.0％、25.0％,而且肿瘤越小,EUS越有诊断优势.结论 EUS对有困难的胆胰管扩张病变诊断有很高的应用价值.%Objective To study the diagnostic value of endoscopic ultrasonography (EUS) in patients with cholangiopancreatic duct dilatation (CPDD).Methods Forty-five patients with CPDD and without any visual or detected obstructive lesions after traditional uhrasonography (US) were re-examined by EUS,CT and MRI.The diagnostic rates of EUS and the other imaging technologies were compared.Results All the 45 patients underwent successful EUS examination.Among them,there were 18 patients with periampullary tumor,10 patients with lower common bile duct stones,1 patient with pancreatic duct stones,3 patients with chronic pancreatitis,1 patient with an intrapancreatic choledochal cyst,4 patients with inflammatory strictures of papilla of duodenum and 2 patients with terminal bile duct inflammatory stenosis.However,1 patient with a lower common bile duct tumor,1 patient with a small pancreatic head carcinoma and 1 patient with sphincter of Oddi dysfunction (SOD) were not diagnosed.The diagnostic rates of obstructive lesions by US,EUS,CT and MRI were 7.1％,92.9％,33.3％,31.0％,respectively.The diagnostic rates of tumor were 10.0％,90.0％,35.0％,25.0％,respectively.As compared with the other examination methods,EUS was best in detecting small carcinoma.Conclusion EUS plays an important role in the diagnosis of lesions causing cholangiopancreatic duct dilatation.
