胆总管远端狭窄超声内镜特征分析

李鸿晔; 韦亚蓉; 李会会; 丁浩; 洪江龙; 孟海轮; 徐张巍; 鲍峻峻; 梅俏

doi:10.3969/j.issn.1001-5256.2021.11.028

胆总管远端狭窄超声内镜特征分析

DOI: 10.3969/j.issn.1001-5256.2021.11.028

安徽医科大学第一附属医院消化内科，合肥 230022

基金项目:

安徽省自然科学基金 (2008085QH415)

详细信息

通信作者:
梅俏，meiqiao@hotmail.com

中图分类号: R657.46
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出版历程
- 收稿日期: 2021-03-17
- 录用日期: 2021-06-13
- 出版日期: 2021-11-20

Endoscopic ultrasound features of distal biliary stricture

Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

Research funding:

Natural Science Foundation of Anhui Province (2008085QH415)

摘要

摘要: 目的回顾性分析胆总管远端狭窄患者的超声内镜(EUS)特征，为EUS评估胆总管远端狭窄提供临床依据。方法收集安徽医科大学第一附属医院2016年4月—2020年3月行EUS检查的175例胆总管远端狭窄的患者临床资料，分析患者的临床表现、实验室、影像学及EUS检查结果，并进行随访，总结胆总管远端狭窄的EUS特征。计数资料两组间比较采用χ²检验，计量资料两组间比较采用t检验。结果 175例胆总管远端狭窄患者中，良性胆总管远端狭窄85例(85/175，48.57%)，恶性胆总管远端狭窄90例(90/175，51.43%)。在恶性胆总管远端狭窄的患者中，EUS显示狭窄长度高于良性胆总管远端狭窄患者[(14.1±3.0) mm vs (7.9±3.0) mm, t=13.358，P＜0.001]，同时EUS发现恶性胆总管远端狭窄患者的管腔低回声占位(57.8% vs 34.1%, χ²=9.843，P=0.002)、周围淋巴结肿大(26.7% vs 12.9%, χ²=5.147，P=0.023)及胰管扩张(51.1% vs 28.2%, χ²=9.532，P=0.002)等特征性改变发生率高于良性胆总管远端狭窄患者。EUS和MRCP两者联合诊断良性胆总管远端狭窄的敏感性为70.6%，诊断恶性胆总管远端狭窄的敏感性为92.2%。结论胆总管远端狭窄具有如较长狭窄、低回声、周围淋巴结肿大及胰管扩张等EUS图像特征，有助于临床中胆总管远端狭窄的鉴别诊断作用。
- 胆总管疾病 /
- 超声检查, 介入性 /
- 疾病特征
Abstract: Objective To investigate the endoscopic ultrasound (EUS) features of distal biliary stricture (DBS), and to provide a clinical basis for the evaluation of DBS by EUS. Methods Related clinical data were collected from 175 patients with DBS who underwent EUS examination in The First Affiliated Hospital of Anhui Medical University from April 2016 to March 2020 to analyze their clinical manifestation, laboratory examination results, imaging findings, and EUS findings, and the patients were followed up to summarize the EUS features of DBS. The chi-square test was used for comparison of categorical data between groups, and the t-test was used for comparison of continuous data between groups. Results Among the 175 patients with DBS, 85(48.57%) had benign DBS and 90(51.43%) had malignant DBS. Compared with the patients with benign DBS, the patients with malignant DBS had a significantly longer length of stricture on EUS (14.1±3.0 mm vs 7.9±3.0 mm, t=13.358, P < 0.001) and significantly higher incidence rates of the characteristic changes on EUS such as hypoechoic space-occupying lesions in lumen (57.8% vs 34.1%, χ²=9.843, P=0.002), peripheral lymph node enlargement (26.7% vs 12.9%, χ²=5.147, P=0.023), and pancreatic duct dilatation (51.1% vs 28.2%, χ²=9.532, P=0.002). EUS combined with magnetic resonance cholangiopancreatography had a sensitivity of 70.6% in the diagnosis of benign DBS and a sensitivity of 92.2% in the diagnosis of malignant DBS. Conclusion The characteristic EUS features of DBS, such as long length of stricture, hypoechoic lesion, peripheral lymph node enlargement, and pancreatic duct dilatation, may help with the differential diagnosis of DBS in clinical practice.
- Common Bile Duct Diseases /
- Ultrasonography, Interventional /
- Disease Attributes

HTML全文

表 1 胆总管远端狭窄的EUS特征分析

EUS特征	良性胆总管远端狭窄(n=85)	恶性胆总管远端狭窄(n=90)	统计值	P值
狭窄段长度(mm)	7.9±3.0	14.1±3.0	t=13.358	＜0.001
不规则不均匀增厚[例(%)]	15(17.6)	25(27.8)	χ²=2.544	0.111
管腔低回声占位[例(%)]	29(34.1)	52(57.8)	χ²=9.843	0.002
周围淋巴结肿大[例(%)]	11(12.9)	24(26.7)	χ²=5.147	0.023
胰管扩张[例(%)]	24(28.2)	46(51.1)	χ²=9.532	0.002
十二指肠乳头占位[例(%)]	13(15.3)	18(20.0)	χ²=0.664	0.415
壶腹部占位[例(%)]	16(18.8)	19(21.1)	χ²=0.143	0.705

下载: 导出CSV

表 2 EUS、MRCP对胆总管远端狭窄的诊断效能

疾病分类	诊断方法	敏感度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)
良性胆总管远端狭窄	EUS	52.9	80.0	71.4	64.3
	MRCP	34.1	81.1	63.0	56.6
	两者联合	70.6	65.6	66.7	70.2
恶性胆总管远端狭窄	EUS	72.2	74.1	74.7	71.6
	MRCP	60.0	95.3	93.1	69.2
	两者联合	92.2	71.8	77.6	89.7

下载: 导出CSV

参考文献(28)

[1]	MA MX, JAYASEKERAN V, CHONG AK. Benign biliary strictures: Prevalence, impact, and management strategies[J]. Clin Exp Gastroenterol, 2019, 12: 83-92. DOI: 10.2147/CEG.S165016.
[2]	BOWLUS CL, OLSON KA, GERSHWIN ME. Evaluation of indeterminate biliary strictures[J]. Nat Rev Gastroenterol Hepatol, 2017, 14(12): 749. DOI: 10.1038/nrgastro.2017.154.
[3]	KAPOOR BS, MAURI G, LORENZ JM. Management of biliary strictures: State-of-the-art review[J]. Radiology, 2018, 289(3): 590-603. DOI: 10.1148/radiol.2018172424.
[4]	LEI RE, JIANG HX, QIN SY. Application of endoscopic ultrasonography in the diagnosis of cholangiocarcinoma[J]. Chin J Dig Surg, 2019, 18(2): 190-193. DOI: 10.3760/cma.j.issn.1673-9752.2019.02.016 雷荣娥, 姜海行, 覃山羽. 超声内镜在胆管癌诊断中的应用[J]. 中华消化外科杂志, 2019, 18(2): 190-193. DOI: 10.3760/cma.j.issn.1673-9752.2019.02.016
[5]	XIE C, ALOREIDI K, PATEL B, et al. Indeterminate biliary strictures: A simplified approach[J]. Expert Rev Gastroenterol Hepatol, 2018, 12(2): 189-199. DOI: 10.1080/17474124.2018.1391090.
[6]	KWEE RM, KWEE TC. Imaging in local staging of gastric cancer: A systematic review[J]. J Clin Oncol, 2007, 25(15): 2107-2116. DOI: 10.1200/JCO.2006.09.5224.
[7]	NOVIKOV A, KOWALSKI TE, LOREN DE. Practical management of indeterminate biliary strictures[J]. Gastrointest Endosc Clin N Am, 2019, 29(2): 205-214. DOI: 10.1016/j.giec.2018.12.003.
[8]	NAKAI Y, ISAYAMA H, WANG HP, et al. International consensus statements for endoscopic management of distal biliary stricture[J]. J Gastroenterol Hepatol, 2020, 35(6): 967-979. DOI: 10.1111/jgh.14955.
[9]	SADEGHI A, MOHAMADNEJAD M, ISLAMI F, et al. Diagnostic yield of EUS-guided FNA for malignant biliary stricture: A systematic review and meta-analysis[J]. Gastrointest Endosc, 2016, 83(2): 290-298. e1. DOI: 10.1016/j.gie.2015.09.024.
[10]	HU B, SUN B, CAI Q, et al. Asia-Pacific consensus guidelines for endoscopic management of benign biliary strictures[J]. Gastrointest Endosc, 2017, 86(1): 44-58. DOI: 10.1016/j.gie.2017.02.031.
[11]	KIM JY, LEE JM, HAN JK, et al. Contrast-enhanced MRI combined with MR cholangiopancreatography for the evaluation of patients with biliary strictures: Differentiation of malignant from benign bile duct strictures[J]. J Magn Reson Imaging, 2007, 26(2): 304-312. DOI: 10.1002/jmri.20973.
[12]	YOO RE, LEE JM, YOON JH, et al. Differential diagnosis of benign and malignant distal biliary strictures: Value of adding diffusion-weighted imaging to conventional magnetic resonance cholangiopancreatography[J]. J Magn Reson Imaging, 2014, 39(6): 1509-1517. DOI: 10.1002/jmri.24304.
[13]	DOMAGK D, WESSLING J, REIMER P, et al. Endoscopic retrograde cholangiopancreatography, intraductal ultrasonography, and magnetic resonance cholangiopancreatography in bile duct strictures: A prospective comparison of imaging diagnostics with histopathological correlation[J]. Am J Gastroenterol, 2004, 99(9): 1684-1689. DOI: 10.1111/j.1572-0241.2004.30347.x.
[14]	KHASHAB MA, FOCKENS P, AL-HADDAD MA. Utility of EUS in patients with indeterminate biliary strictures and suspected extrahepatic cholangiocarcinoma (with videos)[J]. Gastrointest Endosc, 2012, 76(5): 1024-1033. DOI: 10.1016/j.gie.2012.04.451.
[15]	CONWAY JD, MISHRA G. The role of endoscopic ultrasound in biliary strictures[J]. Curr Gastroenterol Rep, 2008, 10(2): 157-162. DOI: 10.1007/s11894-008-0037-4.
[16]	American Society for Gastrointestinal Endoscopy (ASGE) Standards of Practice Committee, ANDERSON MA, APPALANENI V, et al. The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia[J]. Gastrointest Endosc, 2013, 77(2): 167-174. DOI: 10.1016/j.gie.2012.09.029.
[17]	OHSHIMA Y, YASUDA I, KAWAKAMI H, et al. EUS-FNA for suspected malignant biliary strictures after negative endoscopic transpapillary brush cytology and forceps biopsy[J]. J Gastroenterol, 2011, 46(7): 921-928. DOI: 10.1007/s00535-011-0404-z.
[18]	SADEGHI A, MOHAMADNEJAD M, ISLAMI F, et al. Diagnostic yield of EUS-guided FNA for malignant biliary stricture: A systematic review and meta-analysis[J]. Gastrointest Endosc, 2016, 83(2): 290-298. e1. DOI: 10.1016/j.gie.2015.09.024.
[19]	de MOURA D, MOURA E, BERNARDO WM, et al. Endoscopic retrograde cholangiopancreatography versus endoscopic ultrasound for tissue diagnosis of malignant biliary stricture: Systematic review and meta-analysis[J]. Endosc Ultrasound, 2018, 7(1): 10-19. DOI: 10.4103/2303-9027.193597.
[20]	MOURA D, de MOURA E, MATUGUMA SE, et al. EUS-FNA versus ERCP for tissue diagnosis of suspect malignant biliary strictures: A prospective comparative study[J]. Endosc Int Open, 2018, 6(6): E769-E777. DOI: 10.1055/s-0043-123186.
[21]	CHIANG A, THERIAULT M, SALIM M, et al. The incremental benefit of EUS for the identification of malignancy in indeterminate extrahepatic biliary strictures: A systematic review and meta-analysis[J]. Endosc Ultrasound, 2019, 8(5): 310-317. DOI: 10.4103/eus.eus_24_19.
[22]	TOPAZIAN M. Endoscopic ultrasonography in the evaluation of indeterminate biliary strictures[J]. Clin Endosc, 2012, 45(3): 328-330. DOI: 10.5946/ce.2012.45.3.328.
[23]	LEE JH, SALEM R, ASLANIAN H, et al. Endoscopic ultrasound and fine-needle aspiration of unexplained bile duct strictures[J]. Am J Gastroenterol, 2004, 99(6): 1069-1073. DOI: 10.1111/j.1572-0241.2004.30223.x.
[24]	de OLIVEIRA P, de MOURA D, RIBEIRO IB, et al. Efficacy of digital single-operator cholangioscopy in the visual interpretation of indeterminate biliary strictures: A systematic review and meta-analysis[J]. Surg Endosc, 2020, 34(8): 3321-3329. DOI: 10.1007/s00464-020-07583-8.
[25]	KORRAPATI P, CIOLINO J, WANI S, et al. The efficacy of peroral cholangioscopy for difficult bile duct stones and indeterminate strictures: A systematic review and meta-analysis[J]. Endosc Int Open, 2016, 4(3): E263-275. DOI: 10.1055/s-0042-100194.
[26]	NISHIKAWA T, TSUYUGUCHI T, SAKAI Y, et al. Comparison of the diagnostic accuracy of peroral video-cholangioscopic visual findings and cholangioscopy-guided forceps biopsy findings for indeterminate biliary lesions: A prospective study[J]. Gastrointest Endosc, 2013, 77(2): 219-226. DOI: 10.1016/j.gie.2012.10.011.
[27]	MCMAHON CJ. The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound in diagnosis of malignant common bile duct strictures: A critically appraised topic[J]. Abdom Imaging, 2008, 33(1): 10-13. DOI: 10.1007/s00261-007-9305-2.
[28]	NGUYEN NQ, SCHOEMAN MN, RUSZKIEWICZ A. Clinical utility of EUS before cholangioscopy in the evaluation of difficult biliary strictures[J]. Gastrointest Endosc, 2013, 78(6): 868-874. DOI: 10.1016/j.gie.2013.05.020.