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目的探讨胆管内超声联合内镜下逆行胰胆管造影术(ERCP)、KL-6粘蛋白检测在良恶性胆管狭窄诊断中的应用及其价值。方法回顾性分析2010年1月至2014年1月住院诊治的16例经病理证实的恶性胆管狭窄患者和48例经病理证实的良性胆管狭窄患者的临床资料,对两组患者胆管内超声、ERCP、KL-6粘蛋白检查结果进行比较,以病理学诊断为金标准,分析三种方法联合诊断对良恶性胆管狭窄诊断的敏感性与特异性。结果三种方法联合诊断胆管良恶性狭窄的阳性率分别为95.8%、93.8%。胆管内超声对良性狭窄诊断有优势,ERCP对恶性狭窄病因诊断较敏感。三种方法联合诊断胆管恶性狭窄的敏感性为93.75%,特异性为95.83%,明显高于任一方法单独检查的敏感性和特异性。结论胆管内超声对良性狭窄诊断有优势,ERCP对恶性狭窄病因诊断较敏感,三种方法联合诊断能提高对胆管良恶性狭窄病因诊断的敏感性与特异性。
Objective To investigate the value and clinical significance of intra-bile duct ultrasound combined with endoscopic retrograde cholangiopancreatography (ERCP) and KL-6 mucin in the diagnosis of benign and malignant biliary strictures. Methods The clinical data of 16 pathologically confirmed patients with malignant biliary stricture and 48 patients with benign biliary stricture confirmed by pathology from January 2010 to January 2014 were retrospectively analyzed. The results of biliary ultrasound, ERCP , KL-6 mucin test results to compare the pathological diagnosis as the gold standard, the three methods combined diagnosis of benign and malignant biliary stricture diagnostic sensitivity and specificity. Results The positive rates of the three methods in diagnosing benign and malignant biliary strictures were 95.8% and 93.8% respectively. Biliary ultrasound diagnosis of benign stenosis has an advantage, ERCP diagnosis of malignant stenosis more sensitive. The sensitivity of the three methods in the diagnosis of malignant biliary stricture was 93.75% and the specificity was 95.83%, which was significantly higher than the sensitivity and specificity of either method alone. Conclusions Intrahepatic bile duct ultrasound has the advantage in diagnosis of benign stenosis. ERCP is sensitive to the etiological diagnosis of malignant stenosis. The combination of three methods can improve the sensitivity and specificity of etiological diagnosis of benign and malignant biliary strictures.