CAJ | 학술논문

目的：探讨胃肠超声助显剂在超声诊断胆总管中下段病变中的应用价值。方法选取2009年7月-2013年10月我院收治的183例临床怀疑胆总管中下段病变患者，均行经内镜逆行胰胆管造影（ ERCP）、腹腔镜手术或开腹手术。将患者随机分为3组：A组（61例）仅进行常规超声检查；B组（61例）进行常规超声检查+饮温水500 ml后超声复查；C组（61例）进行常规超声检查+口服胃肠超声助显剂后超声复查。对比3种超声检查方法的胆总管全程显示率；然后以术后结果为依据，比较3种方法的胆总管中下段病变诊断符合率。结果 A组、B组、C组胆总管全程显示率依次升高〔24.6%（15/61）、59.0%（36/61）、95.1%（58/61），χ2=62.94，P<0.05〕。ERCP、腹腔镜手术或开腹手术证实胆总管中下段结石171例，胆总管下段肿瘤9例，十二指肠壶腹段肿瘤3例；A组、B组、C组胆总管中下段病变诊断符合率依次升高〔62.3%（38/61）、83.6%（51/61）、98.4%（60/61），χ2=26.51，P <0.05〕。结论饮温水或口服胃肠超声助显剂后超声检查均能明显提高胆总管全程显示率及胆总管中下段病变诊断符合率；口服胃肠超声助显剂效果更佳，且具有无辐射、价廉、操作便捷、可重复性强、易被患者接受等优点，具有临床应用价值。
목적：탐토위장초성조현제재초성진단담총관중하단병변중적응용개치。방법선취2009년7월-2013년10월아원수치적183례림상부의담총관중하단병변환자，균행경내경역행이담관조영（ ERCP）、복강경수술혹개복수술。장환자수궤분위3조：A조（61례）부진행상규초성검사；B조（61례）진행상규초성검사+음온수500 ml후초성복사；C조（61례）진행상규초성검사+구복위장초성조현제후초성복사。대비3충초성검사방법적담총관전정현시솔；연후이술후결과위의거，비교3충방법적담총관중하단병변진단부합솔。결과 A조、B조、C조담총관전정현시솔의차승고〔24.6%（15/61）、59.0%（36/61）、95.1%（58/61），χ2=62.94，P<0.05〕。ERCP、복강경수술혹개복수술증실담총관중하단결석171례，담총관하단종류9례，십이지장호복단종류3례；A조、B조、C조담총관중하단병변진단부합솔의차승고〔62.3%（38/61）、83.6%（51/61）、98.4%（60/61），χ2=26.51，P <0.05〕。결론음온수혹구복위장초성조현제후초성검사균능명현제고담총관전정현시솔급담총관중하단병변진단부합솔；구복위장초성조현제효과경가，차구유무복사、개렴、조작편첩、가중복성강、역피환자접수등우점，구유림상응용개치。
Objective To evaluate the application value of gastrointestinal echogenic contrast agent during the ultra-sonic diagnosis of the middle and lower segment lesions of common bile duct(CBD). Methods 183 patients with suspected le-sions in the middle and lower segment of CBD admitted to our hospital from July 2009 to October 2013 were given ERCP,laparo-scopic surgery or laparotomy. The patients were randomly divided into three groups:group A(61 cases),given regular ultra-sound;Group B(61 cases),given regular ultrasound and re-examination after drinking 500 ml warm water;Group C(61 cases),given regular ultrasound and re-examination after drinking 500 ml gastrointestinal echogenic contrast agent. The display rates of CBD of three different methods were analyzed. Based on the postoperative results,the coincidence rates of three different methods in the diagnosis of middle and lower segment lesions of CBD were analyzed and compared. Results The display rates of CBD of group A,group B and group C were 24. 6%(15/61),59. 0%(36/61)and 95. 1%(58/61)respectively(χ2 =62. 94,P<0. 05). 171 cases were confirmed with stone in the middle and lower segment of CBD,9 cases were confirmed with tumor in the lower segment of CBD and 3 cases were confirmed with tumor of duodenal ampulla. The diagnostic coincidence rates of group A,group B and group C were 62. 3%(38/61),83. 6%(51/61)and 98. 4%(60/61)respectively(χ2 =26. 51,P<0. 05). Conclusion Ultrasound examination after drinking warm water or oral gastrointestinal echogenic contrast agent can obviously increase the display rate of CBD and ultrasound diagnosis coincidence rate of the middle and lower segment of CBD. The effect of oral gastrointestinal echogenic contrast agent is much better. It has advantages of low price,convenient operation,no ra-diation,strong repeatability and can be easily accepted by patients. It has important clinical value.