Blackbourne L H, Earnhardt R C, Sistrom C L, Abbitt P, Jones R S
Department of Surgery, University of Virginia, Charlottesville.
Am Surg. 1994 Sep;60(9):683-90.
Ultrasound is widely advocated as the initial noninvasive imaging study in evaluating suspected biliary obstruction. Some have suggested using ultrasound as the sole diagnostic test before exploratory laparotomy. To evaluate the accuracy of ultrasound in determining the level and etiology of biliary obstruction in patients with biliary dilatation, and to define its role in the evaluation of these patients, we performed a retrospective review of all patients from August 1986 to August 1991 who had biliary dilatation by ultrasound and subsequent endoscopic retrograde cholangiopancreatography and/or a percutaneous transhepatic cholangiography. Forty-two patients were included in this study, and ultrasound delineated the level of obstruction in 88 per cent, defined the etiology of the obstruction in 48 per cent, and diagnosed choledocholithiasis in 33 per cent of patients with this condition. A literature review revealed that ultrasound has a sensitivity of 71 per cent in delineating the level of obstruction, a sensitivity of 57 per cent in defining the etiology of biliary obstruction, and detects choledocholithiasis in 32 per cent of patients with this condition. We conclude that ultrasound is a highly accurate diagnostic test for delineating the level of biliary obstruction. Ultrasound should be the initial radiographic test in the evaluation of the patient with suspected biliary obstruction to guide further radiographic evaluation.
超声作为评估疑似胆道梗阻的初始无创成像检查被广泛提倡。一些人建议在进行剖腹探查术前将超声作为唯一的诊断测试。为了评估超声在确定胆道扩张患者胆道梗阻的部位和病因方面的准确性，并确定其在这些患者评估中的作用，我们对1986年8月至1991年8月期间所有经超声检查发现有胆道扩张且随后接受了内镜逆行胰胆管造影术和/或经皮肝穿刺胆管造影术的患者进行了回顾性研究。本研究纳入了42例患者，超声确定梗阻部位的准确率为88%，确定梗阻病因的准确率为48%，在患有胆总管结石的患者中诊断出胆总管结石的比例为33%。文献综述显示，超声在确定梗阻部位方面的敏感性为71%，在确定胆道梗阻病因方面的敏感性为57%，在患有胆总管结石的患者中检测出胆总管结石的比例为32%。我们得出结论，超声是确定胆道梗阻部位的高度准确的诊断测试。超声应作为评估疑似胆道梗阻患者的初始影像学检查，以指导进一步的影像学评估。
