胆嚢管の超音波内視鏡診断

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  • Endoscopic ultrasonography(EUS) in assessment of anomalies and lesions of the cystic duct.

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Visualizing capability of the cystic duct (CD) by endoscopic ultrasonography (EUS) was assessed in 162 preoperative patients with biliary tract disorders. Scanning was performed via the descending part of the duodenum (DD-scanning), the duodenal bulb (DB-scanning) or the stomach (S-scanning). 1) The CD was visualized as a tortuous tubular structure joining the gallbladder (GB) and the common bile duct (CBD). In some cases, the wall of the CD was imaged as a three -strata structure. 2) The overall visualization rate of CD was 56% (91/162) with a respective rate of 58% (84/144) by DD- / DB-scanning and 39% (7/18) by S-scanning. 3) A high visualization rate of 60-100% was obtained when EUS was intended to observe the ductal system per se in cases of colecyctocholedocholithiasis, CBD cancer, ampullary cancer or anomalous union of the ductal system. 4) Among the three routes of scanning, DD-scanning was the most effective to demonstrate the entire course of the CD with a maximal visualization rate of 41% (14/34), whereas DB- and S-scanning most effectively visualize the proximal (GB-side) part of the CD with a maximal rate of 46% (23/50) and 57% (4/7), respectively. 5) The diagnostic accuracy yielded by EUS for CD lesions was 75% (6/8) for anoma-lous union or tortuous anatomical structure and 100% (17/17) for calculi, malignancies and other conditions, respectively. 6) The overall visualization rate found during the most recent 16 months has increasd up to 88% that was satisfactory. In conclusion, EUS is a useful means to diagnose CD lesions.

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