CAJ | 학술논문

目的探讨胆管腔内超声(IDUS)联合胆汁肿瘤标志物测定对胆管狭窄良恶性的鉴别诊断价值.方法 57例胆管狭窄患者(良性狭窄8例,恶性狭窄49例)行胆管腔内超声检查,同时行血清及胆汁肿瘤标志物[CA19-9、癌胚抗原(CEA)]测定,以手术病理结果为金标准,统计分析腹部超声、CT、磁共振胰胆管成像术(MRCP)、IDUS以及IDUS联合胆汁肿瘤标记物鉴别诊断胆管狭窄良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确度.结果 IDUS和IDUS联合胆汁肿瘤标记物(胆管良恶性鉴别诊断的分界值CA19-9值和CEA值分别为107kU/L和66.71 μg/L)鉴别诊断胆管狭窄良恶性的特异度分别为63.6％ (7/11)和77.8％ (7/9) (P ＞0.05),阳性预测值分别为91.8％(45/49)和95.9％ (47/49) (P ＞0.05),准确度分别为91.2％ (52/57)和94.7％ (54/57) (P ＞0.05),均显著高于腹部超声、CT和MRCP,差异均有统计学意义(P＜0.05).IDUS联合胆汁CEA(远端胆管狭窄良恶性鉴别诊断的分界值为71 μg/L)鉴别诊断远端胆管狭窄良恶性的准确度为97.9％(46/47),明显高于IDUS的87.2％ (41/47),差异有统计学意义(P＜0.05).结论 IDUS联合胆汁肿瘤标记物测定对胆管良恶性狭窄性质的鉴别有较高的价值,联合胆汁CEA测定能够在IDUS基础上进一步提高远端胆管恶性狭窄诊断的准确度.
목적 탐토담관강내초성(IDUS)연합담즙종류표지물측정대담관협착량악성적감별진단개치.방법 57례담관협착환자(량성협착8례,악성협착49례)행담관강내초성검사,동시행혈청급담즙종류표지물[CA19-9、암배항원(CEA)]측정,이수술병리결과위금표준,통계분석복부초성、CT、자공진이담관성상술(MRCP)、IDUS이급IDUS연합담즙종류표기물감별진단담관협착량악성적민감도、특이도、양성예측치、음성예측치급준학도.결과 IDUS화IDUS연합담즙종류표기물(담관량악성감별진단적분계치CA19-9치화CEA치분별위107kU/L화66.71 μg/L)감별진단담관협착량악성적특이도분별위63.6％ (7/11)화77.8％ (7/9) (P ＞0.05),양성예측치분별위91.8％(45/49)화95.9％ (47/49) (P ＞0.05),준학도분별위91.2％ (52/57)화94.7％ (54/57) (P ＞0.05),균현저고우복부초성、CT화MRCP,차이균유통계학의의(P＜0.05).IDUS연합담즙CEA(원단담관협착량악성감별진단적분계치위71 μg/L)감별진단원단담관협착량악성적준학도위97.9％(46/47),명현고우IDUS적87.2％ (41/47),차이유통계학의의(P＜0.05).결론 IDUS연합담즙종류표기물측정대담관량악성협착성질적감별유교고적개치,연합담즙CEA측정능구재IDUS기출상진일보제고원단담관악성협착진단적준학도.
Objective To investigate the diagnostic value of intraductal ultrasonography (IDUS) and bile tumor marker in differential diagnosis of suspected biliary stricture.Methods A total of 57 patients with biliary stricture (8 benign strictures,49 cases of malignant strictures),who underwent IDUS and tests of serum and bile tumor markers (CA19-9 and CEA),were analyzed.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were compared among the outcomes of B-ultrasonography,CT,MRCP,IDUS,as well as IDUS combined with bile tumor markers.Results The specificity of the IDUS and the combined group were 63.6％ (7/11) and 77.8％ (7/9) respectively (P ＞ 0.05).The positive predictive value of the IDUS and the combined group were 91.8％ (45/49) and 95.9％ (47/49) respectively (P ＞0.05).The diagnostic accuracy of the IDUS and the combined group were 91.2％ (52/57) and 94.7％ (54/57) respectively (P ＞0.05).Data of the two groups were significantly higher than conventional imaging like B-ultrasound,CT and MRCP.The accuracy of IDUS combined with bile CEA for the diagnosis of distal bile duct cancer was 97.9％ (46/47),significantly higher than that of IDUS.Conclusion IDUS combined with biliary tumor markers is of high value for distinguishing the bile benign from malignant stricture.IDUS combined with biliary CEA test can improve the diagnostic accuracy of distal malignant biliary stricture diseases.