胆道镜在胆道系统结石相关疾病诊断中的应用价值  

Application value of choledochoscopy in the diagnosis of cholelithiasis related diseases

作　　者：李伟[1] 谢佳明[1] 叶振宇[1] 冯振宇[1] 潘峻[1] 高德康[1] 危少华[1] 陈伟[1] Li Wei;Xie Jiaming;Ye Zhenyu;Feng Zhenyu;Pan Jun;Gao Dekang;Wei Shaohua;Chen Wei(Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第二医院肝胆胰外科,苏州215000

出　　处：《中华消化外科杂志》2020年第8期882-888,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金项目(81602613);苏州市引进临床医学专家团队(SZYJTD201803);苏州市高新区医疗卫生科技项目(2018Z013)。

摘　　要：目的:探讨胆道镜在胆道系统结石相关疾病诊断中的应用价值。方法:采用回顾性描述性研究方法。收集2018年1月至2019年4月苏州大学附属第二医院收治的111例胆道系统结石相关疾病患者的临床病理资料;男45例,女66例;年龄为(55±16)岁,年龄范围为20~89岁。111例患者术中采用胆道镜观察胆道系统黏膜走行及黏膜下血管、增生性病灶等情况。观察指标:(1)患者检查情况。(2)具体病例分析。正态分布的计量资料以±s表示,计数资料以绝对数或百分比表示。结果:(1)患者检查情况:111例患者术中均行胆道镜检查,5例患者行病理学检查。111例患者中,5例患者术中胆道镜检查结果与术前影像学检查结果不一致。(2)具体病例分析。病例1患者术前X线计算机体层摄影术(CT)及磁共振胆胰管成像(MRCP)检查结果示肝内外胆管结石。术中胆道镜检查及胆道镜下电子染色检查结果示胆总管内原胆囊颈管口处黏膜异常,血管增粗,走行紊乱,考虑恶变可能。术中快速冷冻切片病理学检查结果示胆囊颈管炎细胞浸润,局灶腺上皮高级别上皮内瘤变。术后病理学检查结果示胆囊颈管管壁上皮高级别上皮内瘤变,局灶浸润肌壁癌变,3,3-二氨基联苯胺染色检查结果示细胞角蛋白7强阳性。病例2患者术前彩色多普勒超声及MRCP检查结果示胆囊息肉。术中胆道镜检查结果示胆囊息肉伴腺瘤,息肉根部可见1根血管,诊断为胆囊息肉合并腺瘤。内镜窄带成像术(NBI)电子染色检查结果示胆囊息肉伴腺瘤,根部黏膜下可见粗大血管。术中快速冷冻切片病理学检查结果示胆固醇性息肉,局灶腺体成腺瘤样增生。术后病理学检查结果示慢性胆囊炎伴胆固醇性息肉,局灶腺体呈腺瘤样增生。病例3患者术前MRCP检查结果示胆总管结石、肝内胆管结石。术中胆道镜检查结果示肝内胆管结石较大。采用钬激光碎石处理,击碎Objective:To investigate the application value of choledochoscopy in the diagnosis of cholelithiasis related diseases.Methods:The retrospective and descriptive study was conducted.The clinicopathological data of 111 patients with cholelithiasis related diseases who were admitted to the Second Affiliated Hospital of Soochow University between January 2018 and April 2019 were collected.There were 45 males and 66 females,aged(55±16)years,with the range from 20 to 89 years.The mucosal course of biliary system and the submucosal vascular density of the 111 patients were observed by choledochoscopy during operation.Observation indicators:(1)patient examinations;(2)specific case analysis.Measurement data with normal distribution were represented as Mean±SD.Count data were described as absolute numbers or percentages.Results:(1)Patient examinations:111 patients underwent intraoperative choledochoscopy examination,and 5 patients underwent pathological examination.Five of the 111 patients had the results of intraoperative choledochoscopy examination inconsistent with results of preoperative imaging examination.(2)Specific case analysis.Case 1:the patient was diagnosed with intrahepatic and extrahepatic bile duct stones preoperatively by computed tomography(CT)and magnetic resonance cholangiopancreatography(MRCP)examination.Results of intraoperative choledochoscopy examination and electronic staining under choledochoscope showed abnormal mucosa at the opening of the original cholecyst duct in the common bile duct,thickened and disordered blood vessels,which indicated the possibility of malignant transformation.Results of intraoperative rapid frozen histopathological examination showed inflammatory cell infiltration in gallbladder neck and focal glandular epithelial high-grade intraepithelial neoplasia.Results of postoperative pathological examination showed high-grade intraepithelial neoplasia of the wall of gallbladder cervical ducts,focal infiltrating myowall carcinoma and strongly positive of Cytokeratin 7 diaminobenzi

关 键 词：胆道良性疾病 胆道系统腺瘤 胆囊腺肌症 胆道系统慢性炎性狭窄 胆道镜 胆道系统 诊断 应用 

分 类 号：R657.42[医药卫生—外科学]