内镜逆行胰胆管造影刷片仅见异型细胞的胆管狭窄患者恶性狭窄的危险因素分析  

Risk factors for biliary malignancy in indeterminate biliary stricture with atypical cells on endoscopic retrograde brush cytology

作　　者：吴林[1] 王飞[1] 张秀华[1] 李全朋[1] 葛贤秀 聂俊杰[1] 许伯明 蒋国斌[1] 吴小超[1] 季劼[2] 缪林[1] 

机构地区：[1]南京医科大学第二附属医院消化医学中心,南京210011 [2]南京医科大学第一附属医院肝脏外科

出　　处：《中华消化内镜杂志》2016年第8期539-542,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的分析ERCP胆管刷片仅见异型细胞、未明确性质的胆管狭窄进展为恶性狭窄的危险因素。方法纳入2008年1月至2013年12月期间就诊的121名未明确性质的胆管狭窄患者，患者均行ERCP胆管刷片细胞学检查，结果仅见异型细胞。收集的指标包括年龄、性别、胆管狭窄的部位和长度、随访结果和实验室检查结果，并行Logistic回归分析。结果73名（60．3％）患者最终诊断为胆管恶性狭窄，其中66名患者通过组织病理学检查诊断，7名患者通过疾病进展及影像学检查诊断。Logistic回归分析显示，年龄（OR=1．198，95％CI：1．040～1．381）、胆管狭窄长度（OR=7．065，95％CI：1．558～32．041）、血清CA19—9水平（OR=1．023，95％CI：1．006～1．040）、原发性硬化性胆管炎是胆管刷片仅见异型细胞的患者进展为胆管恶性狭窄的独立危险因素。结论对于ERCP胆管刷片仅见异型细胞、未明确性质的胆管狭窄患者，年龄大于51．5岁，胆管狭窄长度大于1．75cm，血清CA19—9水平大于122．05U／ml，伴有原发性硬化性胆管炎是胆管恶性狭窄的危险因素。Objective To identify the risk factors predicting biliary malignancy in indeterminate bil- iary strictures with atypical cells on endoscopic retrograde brush cytology（ERBC）. Methods From January 2008 to December 2013, 121 patients with indeterminate biliary strictures and atypical ceils on ERBC were included. Data of age, gender, the location and length of biliary stricture, follow-up outcomes and experi- mental results were collected and logistic analysis was performed. Results A total of 73 in 121 （60. 3% ）pa- tients were diagnosed as having a malignant stricture, 66 by pathological diagnosis and 7 by disease progress and imaging. Logistic regression analysis showed that age（ OR = 1. 198, 95%CI： 1. 040-1. 381 ） , the length of the stricture （ OR = 7. 065, 95% CI： 1. 558-32. 041 ）, the level of CA 19-9 （ OR = 1. 023, 95% CI： 1. 006- 1. 040） and primary sclerosing cholangitis were the risk factors of biliary malignancy. Conclusion Patient older than 51.5 years old, the length of the stricture larger than 1.75 cm, the level of CA 19-9 higher than 122. 05 U/ml are the risk factors for biliary malignancy in the patients with indeterminate biliary stricture and atypical cells on ERBC.

关 键 词：危险因素 未明确性质胆管狭窄 胆管刷片 异型细胞 

分 类 号：R57[医药卫生—消化系统]