超细电子软式内镜联合腔道超声辅助经皮肝穿刺胆管内钳夹活组织检查的临床应用  

Clinical value of ultra-thin electronic flexible endoscopy combined with intraluminal ultrasound in assisting percutaneous transhepatic biliary stricture biopsy

作　　者：焦德超[1] 雷钦宇 韩新巍[1] 李宗明[1] 毕永华[1] 张全会[1] JIAO Dechao;LEI Qinyu;HAN Xinwei;et al(Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第一附属医院介入科

出　　处：《临床肝胆病杂志》2019年第12期2744-2747,共4页Journal of Clinical Hepatology

基　　金：河南省科技攻关计划基金资助项目(172102310388)

摘　　要：目的探讨Olympus超细电子软式内镜BF-XP290联合腔道超声系统辅助经皮肝穿刺途径胆管狭窄钳夹活组织检查的临床应用价值。方法选取2018年7月-9月在郑州大学第一附属医院使用Olympus超细电子软式内镜BF-XP290直视系统联合腔道超声系统行内镜下观察和狭窄区腔道内超声检查的胆道梗阻患者12例,同期指导透视下经鞘管对病变区进行钳夹活组织检查术。记录镜下观察、超声图像、内镜操作成功率、活组织检查成功率、操作时间、并发症。计量资料组间比较采用t检验。结果12例患者均在静脉麻醉下完成超细软镜、腔内超声检查并满意取材,操作成功率和活组织检查成功率100%,平均操作时间27.8 min。术中10例(83.3%)患者可见胆管狭窄合并肿瘤样新生物,2例患者可见胆管狭窄合并黏膜隆起表现;均与术前影像学梗阻位置符合。腔道内超声示:局限性黏膜隆起6例,管腔均匀性增厚缩窄2例,侵袭外膜者9例。钳夹病理学提示胆管腺癌(高分化7例,中分化2例,低分化1例)。新发现胆管狭窄合并结石2例(16.7%),腔内超声示管腔均匀性增厚,外膜完整,经胆管内钳夹活组织检查证实为纤维结缔组织增生。术后镜下胆管内均有少量出血,未见胆管穿孔、胰腺炎、大量出血等并发症发生。术后TBil、DBil、ALT、AST较术前有明显差异(t值分别为4.38、5.34、6.21、5.76,P值均<0.01)。结论超细电子软式内镜联合腔道超声系统,能够提供胆管狭窄区的直视信息和管壁信息,在保证胆管内钳夹活组织检查技术成功率和阳性率的同时降低并发症发生率,值得进一步推广应用。Objective To investigate the clinical value of Olympus ultra-thin electronic flexible endoscope BF-XP290 combined with the intraluminal ultrasound system in assisting percutaneous transhepatic biliary stricture biopsy.Methods From July to September,2018,12 patients with biliary obstruction underwent endoscopic observation and intraluminal ultrasound of stricture using Olympus ultra-thin electronic flexible endoscope BF-XP290 system combined with luminal ultrasound system in the first Affiliated Hospital of Zhengzhou University,and meanwhile,clamp biopsy was conducted for the lesion through the sheath tube under fluoroscopy.Endoscopic observation,ultrasound image,success rate of endoscopic operation,success rate of biopsy,time of operation,and complications were recorded.The t-test was used for comparison of continuous data between groups.Results All the 12 patients underwent endoscopy and intraluminal ultrasound under intravenous anesthesia,and satisfactory tissue samples were collected.The success rates of operation and biopsy were 100%,and the mean time of operation was 27.8 minutes.Biliary stricture and tumor-like neoplasms were observed in 10 patients(83.3%),and biliary stricture and mucosal bulge were observed in 2 patients;the location of lesions was consistent with the location of obstruction on preoperative imaging.Intraluminal ultrasound showed localized mucosal bulge in 6 patients,even thickening and narrowing of the lumen in 2 patients,and invasion of the outer wall in 9 patients.Clamp biopsy suggested bile duct adenocarcinoma(well-differentiated adenocarcinoma in 7 patients,moderately differentiated adenocarcinoma in 2 patients,and poorly differentiated adenocarcinoma in 1 patient).Two patients(16.7%)were found to have biliary stricture with calculus;intraluminal ultrasound showed even thickening of the lumen with an intact outer wall,and biliary clamp biopsy confirmed fibrous connective tissue hyperplasia.There was a small amount of bleeding in the bile duct after operation in all patients(100%),and

关 键 词：黄疸 阻塞性 内镜超声引导细针穿刺 活组织检查 诊断 

分 类 号：R575[医药卫生—消化系统]