经内镜鼻胆管引流管行超声造影引导对比剂注射在诊断残余胆总管结石中的价值。
The Value of Contrast-Enhanced Ultrasound-Guided Contrast Injection via the Endoscopic Nasobiliary Drainage Duct in Diagnosing Residual Common Bile Duct Stones.
机构信息
Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
Department of Orthopedic Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
出版信息
Biomed Res Int. 2020 Jul 1;2020:3281241. doi: 10.1155/2020/3281241. eCollection 2020.
OBJECTIVES
To investigate the diagnostic value of contrast-enhanced ultrasound- (CEUS-) guided contrast injection via an endoscopic nasobiliary drainage (ENBD) tube on the evaluation for residual stones in common bile duct (CBD).
METHODS
116 patients with CBD stones were treated by endoscopic retrograde cholangiopancreatography and duodenoscopic sphincterotomy incision surgery and ENBD. The US group consisted of 54 patients who underwent US-guided saline injection via the ENBD tube to evaluate for residual CBD stones. The CEUS group consisted of 62 patients who underwent CEUS-guided contrast injection via the ENBD tube to evaluate for residual CBD stones. The length and width of CBD and the detection rate of residual stones before and after NS injection were compared.
RESULTS
In both the US group and the CEUS group, the rate of complete demonstration and the average length and width of CBD before and after injection of NS were all increased significantly. In the US group, 6 patients had verified residual stones, 1 of which was detected by conventional US (detection rate, 1/6), 5 of which were detected by saline injection ultrasound (detection rate, 5/6), and 4 of which were detected by ENBD cholangiography (detection rate, 4/6). There was 1 false positive result on saline injection US and 2 false positives on ENBD cholangiography. In the CEUS group, 6 patients had verified residual stones, none of which were detected by conventional US (detection rate, 0/6), all of which were detected by saline injection CEUS (detection rate, 6/6), and 4 of which were detected by ENBD cholangiography (detection rate, 4/6). There was 1 false positive result on ENBD cholangiography.
CONCLUSIONS
CEUS-guided contrast injection via an ENBD tube helps to provide clear observation of residual stones in the CBD after ERCP with EST and provides comprehensive information for follow-up.
目的
探讨经内镜鼻胆管引流（ENBD）管引导对比剂注射的超声造影（CEUS）在胆总管（CBD）残余结石评估中的诊断价值。
方法
对 116 例 CBD 结石患者进行内镜逆行胰胆管造影和十二指肠镜括约肌切开术及 ENBD 治疗。US 组 54 例患者行 US 引导下经 ENBD 管生理盐水注射评估 CBD 残余结石，CEUS 组 62 例患者行 CEUS 引导下经 ENBD 管对比剂注射评估 CBD 残余结石。比较 NS 注射前后 CBD 长度、宽度及残余结石检出率。
结果
US 组和 CEUS 组完全显示率及 NS 注射前后 CBD 平均长度、宽度均明显增加。US 组 6 例患者经证实有残余结石，其中常规 US 检出 1 例（检出率 1/6），生理盐水注射超声检出 5 例（检出率 5/6），ENBD 胆管造影检出 4 例（检出率 4/6），生理盐水注射超声有 1 例假阳性，ENBD 胆管造影有 2 例假阳性。CEUS 组 6 例患者经证实有残余结石，常规 US 均未检出（检出率 0/6），生理盐水注射 CEUS 均检出（检出率 6/6），ENBD 胆管造影检出 4 例（检出率 4/6），ENBD 胆管造影有 1 例假阳性。
结论
CEUS 引导经 ENBD 管对比剂注射有助于提供 ERCP+EST 后 CBD 残余结石的清晰观察，并为随访提供全面信息。
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