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超声内镜在疑似胆总管结石患者中的应用

Authors
Gavin C Harewood, MD
Maurits J Wiersema, MD
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
徐肇敏, 主任医师，教授

引言

胆总管结石发生在最多可达20%的胆囊结石患者中[1]。通常认为胆总管(common bile duct, CBD)内的结石应取出，即使患者无症状时亦如此，因为这些结石最终会引起腹痛、胰腺炎和/或胆管炎。

胆总管结石的诊断并不总是简单直接的。在无确诊性检测的情况下，临床评估和生化检查对建立明确可靠的诊断而言不够准确。因此，常规应用影像学检查确诊。

过去的金标准检查是内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)，其(相比于其他检查，如超声)的优势在于存在胆总管结石时可允许介入治疗。然而，ERCP是一种有创性检查，可能会遗漏小结石且可能造成诸如胰腺炎的并发症。因此，在行ERCP前明确存在胆总管结石常常是可取的。尚未明确各种特异性检查中的最佳类型、时机及选择，随着新技术的出现需继续重新评估。

最常使用的初始检查是针对肝胆管系统的经腹超声检查。在各种研究中，使用超声从胆道梗阻中检测扩张性胆管的敏感性范围为55%-91%[1-6]。敏感性随着血清胆红素浓度及黄疸持续时间的增加而上升[7]。超声显示扩张性肝外胆管提示可能的梗阻性病变。对于检测胆总管结石，超声与计算机断层扫描(computed tomography, CT)的敏感性相近(存在扩张性胆管时为75%，无扩张性胆管时为50%)。十二指肠内的气体可影响对远端胆总管的观察，从而降低敏感性[8]。

有其他4种方法用于检测：

       

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-15.
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