Vazquez-Sequeiros Enrique, Baron Todd H, Clain Jonathan E, Gostout Christopher J, Norton Ian D, Petersen Bret T, Levy Michael J, Jondal Mary L, Wiersema Maurits J
Developmental Endoscopy Unit Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Gastrointest Endosc. 2002 Sep;56(3):372-9.
Cholangiography and tissue sampling (brush cytology, biopsy) are the standard nonsurgical techniques for determining whether a bile duct stricture is benign or malignant. The aim of this study was to determine whether intraductal US is of assistance in distinguishing benign from malignant biliary strictures.
A retrospective review was undertaken of 30 patients with indeterminate bile duct strictures who underwent ERCP and tissue sampling from September 1999 to November 2000. A 20 MHz over-the-guidewire intraductal US catheter probe was used during ERCP for further examination of the strictures. Final diagnoses of malignant strictures (18 patients) were confirmed histopathologically; confirmation of benign stricture (12 patients) was based on negative tissue sampling plus extended clinical follow-up.
Based on retrospective blinded review, the diagnosis by ERCP was correct in 67% of patients, by tissue sampling in 68%, by combined ERCP/tissue sampling in 67%, and by intraductal US in 90% (p = 0.04 vs. ERCP/tissue sampling) of cases. No complication of intraductal US or ERCP was recorded.
Intraductal US is safe and can improve on the ability at ERCP to distinguish benign from malignant biliary strictures.
胆管造影和组织采样（刷检细胞学、活检）是确定胆管狭窄是良性还是恶性的标准非手术技术。本研究的目的是确定胆管内超声是否有助于区分良性和恶性胆管狭窄。
对1999年9月至2000年11月期间30例胆管狭窄情况不明且接受了内镜逆行胰胆管造影（ERCP）和组织采样的患者进行回顾性研究。在ERCP期间使用20兆赫的导丝型胆管内超声导管探头对狭窄进行进一步检查。恶性狭窄（18例患者）的最终诊断经组织病理学证实；良性狭窄（12例患者）的确认基于组织采样阴性以及延长的临床随访。
基于回顾性盲法评估，ERCP诊断正确的病例占67%，组织采样诊断正确的占68%，ERCP/组织采样联合诊断正确的占67%，胆管内超声诊断正确的占90%（与ERCP/组织采样联合诊断相比，p = 0.04）。未记录到胆管内超声或ERCP的并发症。
胆管内超声是安全的，并且可以提高ERCP区分良性和恶性胆管狭窄的能力。
