腹部超声、CT和MRCP与超声内镜检查诊断胆总管泥沙样结石效能分析*

doi:10.3969/j.issn.1672-5069.2026.04.036

摘要/Abstract

摘要： 目的分析比较超声内镜(EUS)、腹部超声、CT和磁共振胰胆管成像(MRCP)诊断胆总管泥沙样结石的效能。方法 2022年8月～2025年6月我院诊治的胆总管泥沙样结石患者67例和同期胆总管成型结石70例,均接受EUS、腹部超声、CT和MRCP检查,接受经内镜逆行性胰胆管造影或手术治疗。结果在67例胆总管泥沙样结石患者中,EUS检查显示弥漫性点状强回声59例(88.1%),胆管壁模糊或局灶性增厚52例(77.6%),呈分层沉积分布,即近端稀疏、远端聚集46例(68.7%),微弱尾状声影41例(61.2%)和絮状漂浮样回声38例(56.7%);超声、CT、MRCP和EUS诊断成型结石的曲线下面积(AUC)分别为0.92、0.95、0.97和0.99,而诊断泥沙样结石的AUC则分别为0.73、0.78、0.83和0.98,显示EUS诊断泥沙样结石的效能显著优于其他三种检查;在67例被EUS检查诊断的泥沙样结石患者中,其中49例(73.1%)被其他影像学检查漏诊,其中5例(7.5%)为三项检查均提示为阴性;结石漏诊的原因包括结石直径<3 mm、沉积分散或缺乏典型声影等。结论采用EUS检查胆总管泥沙样结石具有重要的临床诊断价值,可以弥补其他影像学检查漏诊的不足。

关键词: 胆总管结石, 泥沙样结石, 超声内镜, 经内镜逆行性胰胆管造影, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of endoscopic ultrasonography (EUS) in comparison with abdominal ultrasonography (US), computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in detecting sludge-like stones in the common bile duct. Methods 67 patients with sludge-like stones and 70 patients with formed stones were encountered in our hospital between August 2022 and June 2025, and all underwent EUS, US, CT and MRCP, and endoscopic retrograde cholangiopancreatography (ERCP) or surgical removal of stones. Results Of 67 patients with sludge-like common bile duct stones proven by EUS, stones presented as diffuse punctate hyperechoic spots in 59 cases (88.1%), blurred bile duct walls or focal thickened in 52 cases (77.6%), stratified deposition in 46 cases (68.7%), faint tapering shadow in 41 cases (61.2%) and flocculent floating echoes in 38 cases (56.7%); the AUCs were 0.92, 0.95, 0.97 and 0.99 by US, CT, MRCP and EUS in detecting formed stones, while they were 0.73, 0.78, 0.83 and 0.98 in detecting sludge-like stones,suggesting EUS detection much superior to conventional imaging; of the 67 patients with sludge-like stones proven by EUS, misdiagnosis by US, CT, MRCP occurred in 49 cases (73.1%), and of which, either US, CT or MRCP didn’t find it in 5 cases (7.5%); reasons of missed diagnosis included diameter of stone less than 3 mm, scattered deposition or lack of typical echo, etc. Conclusion EUS holds significant diagnostic value for sludge-like stones in the common bile ducts, particularly when conventional imaging results are negative or atypical. Future studies should further validate the specific signs of sludge-like stones on EUS and explore its role in monitoring and treatment strategy selection, which might provide a more robust evidence for the precise diagnosis and management of biliary diseases.

Key words: Common bile duct stones, Sludge-like stones, Endoscopic ultrasonography, Endoscopic retrograde cholangiopancreatography, Diagnosis

贺婷, 陈旭峰, 周建飞, 郑扬. 腹部超声、CT和MRCP与超声内镜检查诊断胆总管泥沙样结石效能分析^*[J]. 实用肝脏病杂志, 2026, 29(4): 621-624.

He Ting, Chen Xufeng, Zhou Jianfei, et al. Diagnostic efficacy of endoscopic ultrasonography for sludge-like stones in the common bile ducts: Comparison with abdominal ultrasonography, CT and MRCP[J]. Journal of Practical Hepatology, 2026, 29(4): 621-624.

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腹部超声、CT和MRCP与超声内镜检查诊断胆总管泥沙样结石效能分析^*

Diagnostic efficacy of endoscopic ultrasonography for sludge-like stones in the common bile ducts: Comparison with abdominal ultrasonography, CT and MRCP

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