探讨经胆管腔内超声造影（IB-CEUS）在评估胆道梗阻程度中的临床应用价值。

回顾性分析2008年1月至2012年12月在中山大学附属第三医院诊治的105例胆道梗阻性病变患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男74例，女31例；年龄30～88岁，中位年龄55岁。采用常规超声检查（CUS）和IB-CEUS分别探查105例胆道梗阻性病变患者，以X线或CT胆道造影结果为金标准，比较两种方法的诊断效能。采用McNemar检验评价两种方法对于胆管梗阻程度的诊断与金标准之间的差异性，采用Kappa一致性评价结果的一致性。

对肝内一级、二级胆管完全性梗阻的诊断，两种方法诊断的敏感度及阴性预测值一致，均为100%。IB-CEUS对肝内一级胆管完全性梗阻诊断的特异度、阳性预测值、准确率分别为95.8%、91.9%、97.1%，高于CUS的57.7%、53.1%、71.4%；IB-CEUS对肝内二级胆管完全性梗阻诊断的特异度、阳性预测值、准确率分别为97.3%、83.3%、97.6%，高于CUS的58.6%、24.6%、63.5%。CUS与金标准比较，诊断差异有统计学意义（χ²=28.033，46.000；P<0.05），其对肝内一级、二级胆管完全性梗阻诊断的一致性一般或差（k=0.470，0.252）；而IB-CEUS与金标准诊断比较，差异无统计学意义（P=0.250），且结果一致性好（k=0.936，0.896）。

IB-CEUS能够较准确地评估肝内胆道梗阻程度,效能优于CUS,且与金标准诊断一致性好。

To evaluate the clinical application value of intra-biliary contrast-enhanced ultrasound (IB-CEUS) in the evaluation of degree of biliary obstruction.

Clinical data of105 patients with biliary obstructive disease who were diagnosed and treated in the Third Affiliated Hospital of Sun Yat-sen University from January 2008 to December 2012 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 74 males and 31 females with the age ranging from 30 to 88 years old and the median age of 55 years old. Conventional ultrasound (CUS) and IB-CEUS were used to detect the biliary obstructive lesions in 105 patients. X-ray or CT cholangiography was used as the gold standard for diagnosis. The diagnostic efficacy of two methods was compared. The differences between these two methods and the gold standard in diagnosing the degree of biliary obstruction were evaluated by McNemar test. The consistency of the results was assessed by Kappa consistency.

The diagnostic sensitivity and negative predictive value of two methods were 100% in diagnosing the complete obstruction of primary and second grade intrahepatic bile ducts. The specificity, positive predictive value and accuracy of IB-CEUS in diagnosing the complete obstruction of primary grade intrahepatic bile ducts was respectively 95.8%, 91.9% and 97.1%, higher than 57.7%, 53.1% and 71.4% of CUS. The specificity, positive predictive value and accuracy of IB-CEUS in diagnosing the complete obstruction of second grade intrahepatic bile ducts was respectively 97.3%, 83.3% and 97.6%, higher than 58.6%, 24.6% and 63.5% of CUS. Significant difference was observed in the diagnosis between CUS and gold standard (χ²=28.033, 46.000; P<0.05). CUS was fair or poor for the consistency of results in diagnosing the complete biliary obstruction of primary and second grade intrahepatic bile ducts (k=0.470, 0.252), while no significant difference was observed between IB-CEUS and gold standard (P=0.250) and the consistency of results was good (k=0.936, 0.896).

IB-CEUS can accurately evaluate the degree of intrahepatic biliary obstruction. The efficacy of IB-CEUS is better than that of CUS, and it has a good diagnostic consistency with the gold standard.