Sugiyama M, Wada N, Atomi Y, Kuroda A, Muto T
First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
AJR Am J Roentgenol. 1995 Oct;165(4):867-72. doi: 10.2214/ajr.165.4.7676983.
The aim of this study is to assess the diagnostic usefulness of endoscopic sonography in acute pancreatitis.
Twenty-three patients with clinically diagnosed acute pancreatitis (edematous pancreatitis in 16 and necrotizing pancreatitis with heterogeneous enhancement of the pancreas on contrast-enhanced CT scans in seven) prospectively underwent endoscopic sonography. We studied visualization of the pancreas and the extrahepatic bile duct, capability of differentiation between edematous and necrotizing pancreatitis, and detectability of common bile duct stones and compared the results of endoscopic sonography with those of conventional sonography, CT, and ERCP. In 25 normal subjects, we performed endoscopic sonography to determine the size of the pancreas.
Endoscopic sonography could be performed at the bedside noninvasively and repeatedly. Normal pancreas size was defined from the results of normal subjects. Endoscopic sonography adequately showed the whole length of the pancreas and the extrahepatic bile duct in all cases. On endoscopic sonography, the pancreas was enlarged in 10 of 16 patients with edematous pancreatitis and in all seven patients with necrotizing pancreatitis. In edematous pancreatitis, the echogenicity of the pancreas was normal (four patients) or diffusely hypoechoic (12 patients). In all seven patients with necrotizing pancreatitis, endoscopic sonography showed a pancreatic focal hypoechoic mass with or without interspersed echogenic spots. Endoscopic sonography could differentiate edematous and necrotizing pancreatitis as well as CT could. Conventional sonography depicted the pancreas in only 61% of patients. Endoscopic sonography was highly sensitive in depicting inflammatory peripancreatic spread compared with CT. Endoscopic sonography was more sensitive (100%) than conventional sonography (43%) and CT (57%) for detecting bile duct stones in biliary pancreatitis.
This study suggests that endoscopic sonography may be useful for the diagnosis of acute pancreatitis, particularly in cases of biliary pancreatitis.
本研究旨在评估内镜超声在急性胰腺炎诊断中的应用价值。
23例临床诊断为急性胰腺炎的患者（16例为水肿性胰腺炎，7例为坏死性胰腺炎，增强CT扫描显示胰腺不均匀强化）前瞻性接受了内镜超声检查。我们研究了胰腺和肝外胆管的可视化情况、区分水肿性和坏死性胰腺炎的能力以及胆总管结石的可检测性，并将内镜超声检查结果与传统超声、CT和ERCP的结果进行了比较。对25例正常受试者进行内镜超声检查以确定胰腺大小。
内镜超声可在床边无创且重复进行。根据正常受试者的结果确定正常胰腺大小。内镜超声在所有病例中均能充分显示胰腺和肝外胆管的全长。在内镜超声检查中，16例水肿性胰腺炎患者中有10例胰腺肿大，7例坏死性胰腺炎患者胰腺均肿大。在水肿性胰腺炎中，胰腺的回声正常（4例患者）或弥漫性低回声（12例患者）。在所有7例坏死性胰腺炎患者中，内镜超声均显示胰腺有局灶性低回声肿块，伴有或不伴有散在的回声点。内镜超声区分水肿性和坏死性胰腺炎的能力与CT相当。传统超声仅在61%的患者中显示出胰腺。与CT相比，内镜超声在显示胰腺周围炎症扩散方面具有更高的敏感性。在内镜超声检查中，对于胆源性胰腺炎中胆管结石的检测，其敏感性（100%）高于传统超声（43%）和CT（57%）。
本研究表明内镜超声可能有助于急性胰腺炎的诊断，尤其是在胆源性胰腺炎病例中。
