摘要
目的评价内镜超声检查术(EUS)检查在慢性胰源性腹痛中的诊断价值。方法回顾性分析北京协和医院1991-2004年期间106例疑为慢性胰源性腹痛的患者(除外疑为肿瘤引起的胰腺实性或囊实性占位性病变者)的EUS检查结果及其相关临床资料。结果(1)慢性胰腺炎(CP)占慢性胰源性腹痛病因的首位(57．5%),其次是其他胰腺相关疾病(18．9%),不明原因者占11．3%。(2)EUS诊断CP的敏感性和特异性分别为95．1%和64．4%,阳性预测值和阴性预测值分别为78．4%和90．6%。(3)胰腺实质系统异常(90．2%)是CP的主要EUS表现,其中回声不均伴散在点状强回声或钙化(52．5%)是最常见的表现,而单纯回声不均与局灶回声增强诊断CP的特异性相对较低(P＞0．05)；胰管扩张(34．4%)则是EUS检查CP最常见的胰管系统表现。炎性假瘤型CP多表现为胰头低回声实性占位,与胰腺癌鉴别存在一定难度。(4)EUS与ERCP或BT-PABA诊断的总体符合率分别为：77．8%、70．4%,联合诊断正确率分别为100%、95．8%。结论CP是慢性胰源性腹痛(除外疑为肿瘤引起的胰腺实性或囊实性占位性病变者)最主要的病因。EUS诊断CP的敏感性较高但特异性相对不足。EUS对胰管病变的敏感性稍逊于ERCP。
Objective To evaluate the diagnostic value of EUS in patients with chronic abdominal pain of suspected pancreatic origin. Methods The EUS findings and related clinical data of 106 patients with chronic abdominal pain of suspected pancreatic origin （ excluding the patients with suspected pancreatic malignancies） from 1991 to 2004 in PUMCH were retrospectively analyzed. Results （ 1 ） The principal disease interpreting the chronic abdominal pain of suspected pancreatic origin （ excluding pancreatic malignancies） was chronic pancreatitis （CP）（57. 5% ）, the following contributions were other pancreatic diseases （18. 9% ） and unknown diseases （11.5% ）. （2） The sensitivity and specificity of EUS for diagnosing CP was 95. 1% and 64. 4% respectively, the positive predictive value （ PPV ） and negative predictive value （NPV） was 78.4% and 90. 6% respectively. （5） Abnormalities of pancreatic parenchyma structure based on EUS were the main findings （90. 2% ） in patients with CP and non-homogeneous echo pattern combined with hyper echoic dots or calcification was the predominant feature （52. 5% ）. The value of isolated inhomogeneity and focal enhanced echogenicity for diagnosing CP were limited （ P 〉 O. 05）. Abnormalities of pancreatic ductal system were presented in 65.9% of patients with CP and dilation of pancreatic duct was the major feature （54. 4% ）. CP with focal mass （inflammatory pseudotumor） was usually presented as hypo echoic mass in the pancreatic head based on EUS （90%）, which was similar to the EUS feature of pancreatic cancer. （4） The general accordant rate based on EUS with ERCP or BT-PABA were 77.8% and 70. 4% respectively, and the correct rate based on combine diagnosis were 100% and 95. 2%. Conclusion CP is the main source of chronic abdominal pain of suspected pancreatic origin （excluding pancreatic malignancies）. EUS has good sensitivity but inadequate specificity for diagnosing CP, while ERCP may be more sensitive than EUS for detecting pancreatic ductal lesions. Pancreatic parenchymal abnormalities contribute the major EUS features of CP but the value of isolated inhomogeneity and focal enhanced echogenicity for diagnosing CP are limited.
出处
《中华消化内镜杂志》
2006年第3期164-168,共5页
Chinese Journal of Digestive Endoscopy
关键词
内镜超声检查术
慢性胰腺炎
腹痛
Endoscopic ultrasonography
Chronic pancreatitis
Abdominal pain
