经胆道超声造影诊断胆总管术后残石的临床分析
| 作者: |
1王瓯越,
1吴硕东
1 中国医科大学附属盛京医院 第二普通外科，辽宁 沈阳 110004 |
| 通讯: |
吴硕东
Email: wushuodong@yahoo.com.cn |
| DOI: | 10.3978/.2018.02.008 |
摘要
目的：探讨经胆道超声造影检查在胆总管术后残石诊断中应用价值。
方法：选择2016年8月—2017年12月行开腹或腹腔镜下胆总管切开探查取石，胆总管留置T管引流术后返院患者41例与经皮经肝胆道穿刺引流（PTCD）后并进行窦道扩张取石患者10例。患者入院后经T管或PTCD扩张管窦道胆道镜探查术前行经胆道超声造影检查、X线胆道造影检查；记录超声造影联合生理盐水注入前后观察到胆总管长度、直径等数据；以胆道镜探查结果为胆总管残石是否存在为金标准，分析其他两种方法诊断残石的准确性。
结果：所有患者均完成3种检查。92.2%（47/51）的患者在超声造影联合生理盐水胆道注入下可观察到胆总管全程。胆道镜探查结果为标准，超声造影诊断残石符合率为88.2%（45/51），敏感度为78.3%，特异度为96.4%，一致性检验κ值为0.76；X线胆道造影检查诊断残石符合率为82.4%（42/51），敏感度为60.9%，特异度为100%，一致性检验κ值为0.63。
结论：经胆道超声造影检查在胆总管探查留置T管术后及PTCD窦道扩张术后残石检查中可有效观察胆总管形态及其中残石，结合X线胆道造影可提高胆道术后胆总管残石诊断率。
关键词：
胆总管结石病/诊断；超声检查；胆管造影术
方法：选择2016年8月—2017年12月行开腹或腹腔镜下胆总管切开探查取石，胆总管留置T管引流术后返院患者41例与经皮经肝胆道穿刺引流（PTCD）后并进行窦道扩张取石患者10例。患者入院后经T管或PTCD扩张管窦道胆道镜探查术前行经胆道超声造影检查、X线胆道造影检查；记录超声造影联合生理盐水注入前后观察到胆总管长度、直径等数据；以胆道镜探查结果为胆总管残石是否存在为金标准，分析其他两种方法诊断残石的准确性。
结果：所有患者均完成3种检查。92.2%（47/51）的患者在超声造影联合生理盐水胆道注入下可观察到胆总管全程。胆道镜探查结果为标准，超声造影诊断残石符合率为88.2%（45/51），敏感度为78.3%，特异度为96.4%，一致性检验κ值为0.76；X线胆道造影检查诊断残石符合率为82.4%（42/51），敏感度为60.9%，特异度为100%，一致性检验κ值为0.63。
结论：经胆道超声造影检查在胆总管探查留置T管术后及PTCD窦道扩张术后残石检查中可有效观察胆总管形态及其中残石，结合X线胆道造影可提高胆道术后胆总管残石诊断率。
Clinical analysis of intrabiliary contrast-enhanced ultrasonography for residual stone detection after choledochal surgery
CorrespondingAuthor:WU Shuodong Email: wushuodong@yahoo.com.cn
Abstract
Objective: To investigate the application value of intrabiliary contrast-enhanced ultrasonography (CEUS) in residual stone detection following choledochal surgery.
Methods: Forty-one patients readmitted after undergoing open or laparoscopic common bile duct exploration and stone extraction with choledochal T-tube drainage, and 10 patients undergoing stone extraction through sinus tract dilation after percutaneous transhepatic cholangial drainage (PTCD) from August 2016 to January 2018 were enrolled. All patients underwent intrabiliary CEUS and X-ray cholangiography before choledochoscopic exploration through T-tube sinus tract or dilated PTCD sinus tract after admission. The length and diameter of the common bile duct before and after CEUS combined with saline injection were recorded. Using the results of choledochoscopic exploration as a golden standard for residual stones, the accuracies of the other two methods for residual stone detection were analyzed.
Results: All the three examinations were completed in these patients. The full length of the common bile duct was exposed in 92.2% (47/51) patients under CEUS combined with saline injection. Using the results of choledochoscopic exploration as a standard, the coincidence rate of residual stone detection was 88.2% (45/51) for CEUS, with a sensitivity of 78.3%, specificity of 96.4% and κ value for the consistency of 0.76; the coincidence rate of residual stone detection was 82.4% (42/51) for X-ray cholangiography, with a sensitivity of 60.9%, specificity of 100% and κ value for the consistency of 0.63.
Conclusion: Intrabiliary CEUS for residual stone detection after T-tube placement or PTCD sinus tract dilation can effectively observe the full length of the common bile duct and the residual stones inside, and its residual stone detection rate can be improved by combination with X-ray cholangiography.
Keywords：
Choledocholithiasis/diag; Ultrasonography; Cholangiography
Methods: Forty-one patients readmitted after undergoing open or laparoscopic common bile duct exploration and stone extraction with choledochal T-tube drainage, and 10 patients undergoing stone extraction through sinus tract dilation after percutaneous transhepatic cholangial drainage (PTCD) from August 2016 to January 2018 were enrolled. All patients underwent intrabiliary CEUS and X-ray cholangiography before choledochoscopic exploration through T-tube sinus tract or dilated PTCD sinus tract after admission. The length and diameter of the common bile duct before and after CEUS combined with saline injection were recorded. Using the results of choledochoscopic exploration as a golden standard for residual stones, the accuracies of the other two methods for residual stone detection were analyzed.
Results: All the three examinations were completed in these patients. The full length of the common bile duct was exposed in 92.2% (47/51) patients under CEUS combined with saline injection. Using the results of choledochoscopic exploration as a standard, the coincidence rate of residual stone detection was 88.2% (45/51) for CEUS, with a sensitivity of 78.3%, specificity of 96.4% and κ value for the consistency of 0.76; the coincidence rate of residual stone detection was 82.4% (42/51) for X-ray cholangiography, with a sensitivity of 60.9%, specificity of 100% and κ value for the consistency of 0.63.
Conclusion: Intrabiliary CEUS for residual stone detection after T-tube placement or PTCD sinus tract dilation can effectively observe the full length of the common bile duct and the residual stones inside, and its residual stone detection rate can be improved by combination with X-ray cholangiography.