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超声内镜在慢性胰腺炎中的应用

Authors
Michael B Wallace, MD, MPH
Massimo Raimondo, MD, FACG
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
卜锐, 副主任医师

引言

超声内镜(endoscopic ultrasound, EUS)最初被研发用于提高胰腺的显像[1-4]。由于胰腺与胃及十二指肠腔紧密相邻，使得EUS可以不受背覆肠道中的气体干扰而获得高分辨率的图像。 (参见“超声内镜：正常胰胆管的解剖学”)

EUS诊断慢性胰腺炎(chronic pancreatitis, CP)依赖于定量和定性的关于胰腺实质和导管的诊断标准，其中一些已被发布。通常认为如果不符合任何一项诊断标准，则不太可能存在CP，而出现大于等于5项标准时，则可能存在CP，即使是内镜逆行胆道造影(endoscopic retrograde cholangiography, ERCP)及胰腺功能的标准检查仍为正常时。如果EUS发现较少(1-4条)的特征，其临床意义不明确，尤其是当其他诊断方法如ERCP和胰腺功能检查为正常时。

EUS可识别其他显像方法无法识别的若干项CP特征。这些特征包括胰管的高回声边缘、胰腺实质呈不明显的分叶状、胰腺实质的小囊肿性改变及侧支胰管扩张(影像 1A-B)。检测这些细微改变的能力提出了如何定义慢性胰腺炎及EUS是否过于敏感的问题。然而，越来越多的证据表明，由EUS检测到的这些早期改变与CP的组织学变化是相关的，并预测可能进展为更明显的疾病。

正常胰腺的EUS表现

已介绍了数种正常的胰腺声像图表现，这使得可对EUS中所见异常进行识别。以下发现来自一项纳入130,951例患者的研究，该研究采用频率为3.5mHz或5mHz探头经腹超声(transabdominal ultrasonography, TUS)对患者进行筛查[5]：

  • 采用TUS及EUS测量胰管直径的结果相似，仅有0.49%的受检者胰管扩张(＞3mm)，胰管扩张在男性和年长者中更为常见。胰管直径有明显随年龄增长而增宽的趋势。
  • 在0.21%的受检者检出胰腺的囊性病变，0.05%中检出钙化。然而，与EUS相比，TUS可能低估了这些异常的患病率。

             

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Literature review current through: 2017-06 . | This topic last updated: 2015-10-20.
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