Tamada K, Yasuda Y, Tomiyama T, Oohashi A, Kanai N, Aizawa T, Wada S, Tano S, Miyata T, Satoh Y, Ido K, Kimura K
Departments of Gastroenterology, Surgery, and Pathology, Jichi Medical School, Yakushiji, Tochigi, Japan.
Gastrointest Endosc. 1999 Apr;49(4 Pt 1):488-92. doi: 10.1016/s0016-5107(99)70048-9.
Although congenital bile duct dilatation is frequently associated with biliary tract cancer, conventional cholangiography often does not demonstrate small ductal tumors. This is the first prospective study of the value of intraductal ultrasonography (US) in the examination of the extrahepatic bile ducts in patients with congenital bile duct dilatation.
Intraductal US via a transpapillary route was used in consecutive patients with congenital bile duct dilatation. A 2.0 mm diameter, 20 MHz frequency catheter probe was used. The images were correlated with the results of histologic examination of the resection specimens.
Intraductal US was performed successfully via the transpapillary route in 8 of 10 patients. In the other 2 patients, the percutaneous transhepatic route was used. In the 6 patients with cylindrical dilatation, intraductal US demonstrated the entire extrahepatic bile duct. In 1 patient, it showed a bile duct cancer not demonstrated by cholangiography. In 2 of the 4 patients with cystic dilatation, intraductal US did not demonstrate the entire extrahepatic bile duct because of the low penetration depth of the probe. Percutaneous transhepatic cholangioscopy was required in these patients.
Intraductal US is useful for demonstrating cancers in the extrahepatic bile ducts in patients with congenital cylindrical ductal dilatation.
尽管先天性胆管扩张常与胆道癌相关，但传统胆管造影术往往无法显示小的胆管肿瘤。这是第一项关于导管内超声（US）在先天性胆管扩张患者肝外胆管检查中价值的前瞻性研究。
对连续性先天性胆管扩张患者采用经乳头途径进行导管内超声检查。使用直径2.0mm、频率20MHz的导管探头。图像与切除标本的组织学检查结果相关联。
10例患者中有8例通过经乳头途径成功进行了导管内超声检查。另外2例患者采用经皮经肝途径。在6例圆柱状扩张患者中，导管内超声显示了整个肝外胆管。在1例患者中，显示出胆管造影未发现的胆管癌。在4例囊性扩张患者中的2例，由于探头穿透深度低，导管内超声未显示整个肝外胆管。这些患者需要进行经皮经肝胆管镜检查。
导管内超声有助于显示先天性圆柱状胆管扩张患者肝外胆管中的癌症。
