十二指肠镜下经乳头胆管腔内球囊扩张联合胆管活检对肝外胆管狭窄的诊治价值  

The application value of balloon dilatation combined with biopsy forceps under the endoscopic retrograde cholangiogancretography in diagnosis of extrahepatic bile duct stricture

作　　者：李祥玉 仲恒高[1] 王芸[1] 丁瞿晨 王娟[1] 仇咏欣 杨丽华[1] LI Xiangyu;ZHONG Henggao;WANG Yun(Digestive Medicine Center,The Second Hospital Affiliated to Nanjing Medical University, Jiangsu, Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院消化医学中心,南京市210011

出　　处：《河北医药》2020年第7期998-1002,共5页Hebei Medical Journal

摘　　要：目的评价经内镜逆行胰胆管造影(endoscopic retrograde cholangiogancretography,ERCP)下球囊扩张联合活检钳在肝外胆管狭窄尤其是在肝外胆管癌诊治中的应用价值。方法回顾性分析30例肝外胆管狭窄的患者,在ERCP下行十二指肠乳头部及胆总管下段球囊扩张术,所有患者通过活检钳,钳取组织行病理学检查,并根据患者的病情及与患者家属沟通后的意见结果,分别采取相应的内镜治疗方法,包括支架置入引流(endoscopic biliary drainage,EBD)、鼻胆管引流(endoscopic nose-biliary drainage,ENBD)或外科手术治疗。结果30例患者均成功进行了ERCP深插管,并在内镜下钳取到疑似病变组织行病理学检查。30例行ERCP的患者中,8例留置ENBD,12例置入EBD,EBD联合ENBD者7例,3例患者既未置入EBD也未留置ENBD。内镜下治疗后患者腹痛、腹胀等不适症状较术前明显缓解,血清总胆红素、直接胆红素、间接胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、碱性磷酸酶、谷氨酰转肽酶水平术后均明显降低(P<0.05)。明确诊断为肝外胆管癌的患者,其血清肿瘤标志物(CA125、AFP)术后较术前改变差异有统计学意义(P<0.05)。与影像学相比,ERCP活检组织病理对肝外胆管病变的诊断更有意义(P=0.007)。ERCP与外科手术对肝外胆管癌的诊断无明显差异(P=0.5),而影像学对肝外胆管癌的诊断明显低于外科手术病理(P=0.031)。结论经ERCP下胆管腔内球囊扩张术联合活组织检查,可用于肝外胆管狭窄的病理学诊断,其诊断可靠性优于CT、MRCP等影像学检查,其方法安全、创伤小。Objective To investigate the application value of balloon dilatation combined with biopsy forceps under the endoscopic retrograde cholangiogancretography(ERCP)in diagnosis of extrahepatic bile duct stricture.Methods The clinical data about 30 patients with extrahepatic bile duct stricture were retrospectively analyzed.During the balloon dilatation of duodenal papilla and lower common bile duct under ERCP,all the patients received biopsy pathological examinations by camping the tissues with biopsy forceps.According to conditions and the results of the communication with their family menbers,the corresponding endoscopic treatment was performed,including endoscopic biliary drainage(EBD),endoscopic nose-biliary drainage(ENBD)or surgical treatment.Results A total of 30 patients underwent successfully ERCP deep intubation,and the pathological examination was successfully performed by clamping the suspected lesion tissues under endoscopy,of whom,8 cases received ENBD,12 cases underwent EBD,and 7 cases received both ENBD and EBD,however,3 cases underwent neither EBD nor ENBD.After ERCP treatment,the discomfort symptoms of patients were obviously relieved.,and the levels of bilirubin,aminotransferase,alkaline phosphatase,γ-glutamyl transpeptidase were significantly decreased(P<0.05).There were significant differences in the serum levels of tumor markers(CA125,AFP)befeore RECP and after RECP(P<0.05).As compared with imaging examination,the ERCP bioptic histopathology was more meaningful in diagnosis of extrahepatic bile duct lesions(P<0.01).There was no significant difference in diagnosis of extrahepatic bile duct carcinoma between ERCP and surgery(P>0.05),however,the accuracy of imaging examination in diagnosis of extrahepatic bile duct carcinoma was significantly lower than that by surgical pathological examination(P<0.05).Conclusion The balloon dilatation combined with biopsy forceps under the endoscopic retrograde cholangiogancretography can used in the pathological diagnosis of extrahepatic bile duct stricture,and it

关 键 词：肝外胆管狭窄 内镜下逆行胰胆管造影 球囊扩张 活组织检查 

分 类 号：R657.46[医药卫生—外科学]