The Clinic Study Of Intraductal Ultrasonographic Diagnosis And Endoscopic Treatment In Patients With Benign And Malignant Biliary Stricture

Objective:The aim of this study was to investigate whether intraductal US is of assistance in distinguishing benign from malignant biliary strictures, and to aquire the measures and clinical value of endoscopic treatment in patients with benign and malignant biliary stricture.Methods:The first section:The clinical records of 236 patients with biliary stricture from January 2004 to March 2009 was reviewed retrospectively with the examination of BUS,CT,ERCP,MRCP and IDUS. All patients, including 154 men and 82 women with a mean age of 59.9 years. We evaluated the advantage and disadvantage of each examination, and decided which was the best method in diagnosis benign and malignant biliary stricture.The second section:There were 92 patients with malignant biliary, of which 64 were received endoseopic treatment.we observed the change of hepatic-function, evaluated the clinical effection of ERBD and EMBE.Results:Among the 236 patients, Final diagnoses of malignant strictures (92 patients) were confirmed histopathologically; confirmation of benign stricture (144 patients) was based on negative tissue sampling plus extended clinical follow-up.Sensitivity, specificity, positive predictive values, negative predictive values, accuracy of IDUS for malignant bile duct strictures were 92.2%,78.1%,83.3%,89.9%,89.7 %. The accuracy of BUS,CT,MRCP,ERCPand IDUS were 60.2%(142/236),66.8%(119/178),74.2%(98/132),76.1%(159/209),89.7%(165/184).The accuracy of BUS+ERCP+IDUS,BUS+CT+MRCP,BUS+CT+ERCP,BUS+MRCP+ERCP 97.8%(231/236),90.3%(213/236),92.4%(218/236) and 95.3%(225/236).Endoscopic drainage sueeess rate was 92.4% in patients with malignant biliary strictures. The level of TBIL,DBIL was significant different after endoscopic treatment between the two groups, but is similar with the each other.But the survival of EMBE is longer than ERBD(p<0.05).Conclusion:IDUSwas the best method in diagnosis of biliary strieture of the study, while BUS could be regard as useful examination.Beeause of un-invasive, MRCP was regard as reliable examination in biliary strieture. Endoseopy drainage in patients with malignant strictures was less invasive,safe,effective.