梗阻性黄疸经皮肝穿刺胆道活检与影像学诊断比较研究  

Percutaneous tranhepatic biliary biopsy versus spiral CT for diagnosis of obstructive jaundice

作　　者：陈伟志[1] 吴刚[2] 

机构地区：[1]辽宁医学院附属第一医院放射线科,辽宁锦州121001 [2]辽宁医学院附属第一医院肝胆外科,辽宁锦州121001

出　　处：《中国普通外科杂志》2013年第8期1007-1010,共4页China Journal of General Surgery

摘　　要：目的:比较经皮肝穿刺胆道造影术(PTC)下胆道活检和螺旋CT对梗阻性黄疸的诊断价值。方法:收集2010年3月—2012年12月78例因梗阻性黄疸住院的患者资料,患者均进行PTC活检和螺旋CT诊断,根据外科手术病理活检结果对两种方法进行比较。结果:78例患者中,9例确诊为良性梗阻性黄疸,69例确诊为良性梗阻性黄疸,后者包括胆管上皮源性肿瘤46例,非胆管上皮源性肿瘤23例;PTC活检灵敏度85.51%,特异度66.67%;螺旋CT灵敏度78.26%,特异度77.78%。PTC活检灵敏度高于螺旋CT,特异度低于螺旋CT,差异均有统计学意义(均P<0.05)。46例胆管癌患者中,PTC活检阳性43例(93.48%),螺旋CT阳性37例(80.43%),23例非胆管癌患者中,PTC活检阳性19例(82.61%),螺旋CT阳性17例(73.91%);PTC活检灵敏度均高于螺旋CT(P<0.05),且PTC活检对胆管癌灵敏度高于非胆管癌(P<0.05),螺旋CT两种病理来源灵敏度差异无统计学意义(P>0.05)。结论:PCT活检对不同类型梗阻性黄疸尤其是胆管癌诊断灵敏度均高于螺旋CT,但禁忌证多,临床可酌情选择不同方法辅助诊断。Objective：To compare the diagnostic value of biopsy under percutaneous transhepatic cholangiography（PTC） versus spiral CT in obstructive jaundice.Methods：The clinical records of 78 patients admitted from 2010 March to 2012 December due to obstructive jaundice were collected.All patients underwent either PTC biopsy or spiral CT examination,and the two diagnostic methods were compared according to the results of the surgical pathology biopsy.Results：Of the 78 patients,9 cases were identified as benign obstructive jaundice,and 69 cases were diagnosed as malignant obstructive jaundice that included 46 biliary epithelial tumors and 23 non-biliary epithelial tumors.The sensitivity and specificity of PTC biopsy was 85.51% and 66.67%,and those of spiral CT was 78.26% and 77.78%,respectively.The sensitivity of PTC biopsy was higher,but its specificity was lower than that of spiral CT,and both differences were statistically significant（both P＆lt;0.05）.In the 46 patients with bile duct cancer,43 cases were positive by PTC biopsy（93.48%） and 37 cases were positive by spiral CT（80.43%）;in the 23 patients with non-bile duct cancer,19 cases were positive by PTC biopsy（82.61%）,and 17 cases were positive by spiral CT（73.91%）.The sensitivity of PTC biopsy in these patients was higher than that of spiral CT（P＆lt;0.05）,and further,the sensitivity of PTC biopsy for biliary epithelial tumors was higher than that for non-biliary epithelial tumors（P＆lt;0.05）,while no such difference was noted in spiral CT for the tumors of the two origins（P＆gt;0.05）.Conclusion：The sensitivity of PTC biopsy for diagnosis of different types of obstructive jaundice,especially those due to bile duct cancer,is higher than that of spiral CT,but it has many contraindications,so other different methods also can be used according to the clinical needs.

关 键 词：黄疸 阻塞性 诊断 活组织检查 体层摄影术 螺旋计算机 

分 类 号：R657.4[医药卫生—外科学]