胆管腔内超声及胆管刷片鉴别良恶性胆管狭窄的价值  

Diagnostic value of intraductal uitrasonography and brush cytology on differentiating malignant and benign biliary stricture

作　　者：郑汝桦 王雷 姚玉玲 李运红 曹俊 邹晓平[1] 

机构地区：[1]南京大学医学院附属南京鼓楼医院消化内科,南京210008

出　　处：《中华消化内镜杂志》2017年第11期787-790,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨胆管腔内超声检查（IDUS）及胆管刷片在鉴别诊断良恶性胆管狭窄中的应用及价值。方法回顾性分析2007年9月至2015年10月行经内镜逆行胆管造影术（ERC）及IDUS的胆管狭窄患者资料，分析其IDUS特点及胆管刷片结果，并与手术病理结果对比，探讨IDUS和胆管刷片鉴别胆管良恶性狭窄的价值。结果共有230例胆管狭窄患者行ERC及IDUS，其中206例患者同时行胆管刷片检查，刷片结果为恶性者84例。230例患者中有87例患者行手术治疗，其中75例手术病理为恶性，包括胆管腺癌65例，胰腺癌8例，壶腹部腺癌2例。以手术病理为金标准，IDUS正确诊断恶性胆管狭窄72例、良性胆管狭窄9例，据此分析IDUS诊断恶性胆管狭窄的敏感度为96．0％，特异度75．O％，阳性预测值96．0％，阴性预测值75．0％。65例手术患者术前行ERC联合胆管刷片及IDUS检查，其中56例手术病理为恶性，细胞刷片正确诊断恶性胆管狭窄31例，良性胆管狭窄9例，据此分析胆管刷片诊断胆管恶性狭窄的敏感度为55．4％，特异度100％，阳性预测值100％，阴性预测值26．5％。该65例患者如应用IDUS联合胆管刷片，则诊断胆管恶性狭窄的敏感度上升为94．6％，但特异度下降至77．8％，阳性预测值为96．4％，阴性预测值为70．0％。结论IDUS对诊断恶性胆管狭窄有着很高的敏感度及良好的特异度，而胆管刷片对诊断恶性胆管狭窄有着很高的特异度及阳性预测值，但敏感度及阴性预测值低，如联合使用IDUS及胆管刷片技术，则可大幅度提高诊断的敏感度及阴性预测值，但是诊断特异度及阳性预测值有轻微下降，提示IDUS在诊断恶性胆管狭窄中存在一定程度的过判断及假阳性率。Objective To investigate the diagnostic value of intraductal ultrasonography （IDUS） with or without brush cytology on distinguishing malignant from benign biliary stricture. Methods The data of patients with biliary stricture, who underwent endoscopic retrograde cholangiography （ ERC ） and IDUS in Drum Tower Hospital from September 2007 to October 2015 were retrospectively analyzed. Features of IDUS images and results of brush cytology were compared with postoperative histological results to evaluate the diagnostic yield of IDUS and brush cytology on differential diagnosis of malignant biliary stricture. Results A total of 230 patients with biliary stricture underwent ERC and IDUS, and 206 patients meanwhile received brush cytology, including 84 cases of malignant biliary stricture. Of the 230 patients, 87 cases underwent surgery, and 75 revealed malignant results, including 65 cases of cholangiocarcinoma, 8 cases of pancreatic adenocarcinoma, and 2 cases of periampullary adenocarcinoma. Using postoperative pathologic results as the gold standard, 72 malignant and 9 benign biliary strictures were correctly diagnosed by IDUS. The sensitivity, specificity, positive predictive value, and negative predictive value of IDUS for diagnosis of malignant biliary stricture was 96.0%, 75.0%, 96.0%, and 75.0%, respectively. Sixty-five patients underwent IDUS with brush cytology during ERC before surgery, and 56 out of 65 showed malignant results. Thirty-one malignant and 9 benign biliary stricture were correctly diagnosed by brush cytology. The sensitivity, specificity, positive predict value, and negative predict value of brush cytology for diagnosis of malignant biliary stricture was 55.4%, 100%, 100%, and 26. 5%, respectively. If brush cytology combined with IDUS to diagnose malignant biliary stricture, the sensitivity rose up to 94. 6%, while the specificity went down to 77.8%, and the positive and negative predictive value was 96.4% and 70.0%, respectively. Conclusion IDUS exhibited excellent sensitivity and spec

关 键 词：腔内超声检查 胆管造影术 内窥镜逆行 胆管狭窄 细胞刷片 

分 类 号：R445.1[医药卫生—影像医学与核医学] R657.4[医药卫生—诊断学]