内镜下逆行胰胆管造影术中推送管辅助胆道活检对胆管恶性狭窄的诊断价值  

Value of push-tube assisted biliary biopsy in endoscopic retrograde cholangiopancreatography to the diagnosis of malignant biliary strictures

作　　者：王培学 杨芬 张军 王正峰[2] 苗龙[2] 谭小平[1] WANG Peixue;YANG Fen;ZHANG Jun;WANG Zhengfeng;MIAO Long;TAN Xiaoping(Department of Gastroenterology,the First Affiliated Hospital of Yangtze University,the First People’s Hospital of Jingzhou,Jingzhou,Hubei 434000,China;Department of General Surgery,the First Hospital of Lanzhou University,Lanzhou,Gansu 730000,China)

机构地区：[1]长江大学附属第一医院,荆州市第一人民医院消化内科,湖北荆州434000 [2]兰州大学第一医院普外科,甘肃兰州730000

出　　处：《中华实用诊断与治疗杂志》2024年第3期289-293,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：湖北省科技厅重点项目(2022BCE009)。

摘　　要：目的观察内镜下逆行胰胆管造影术(ERCP)中应用推送管辅助行胆道活检的组织病理检查结果,探讨其诊断胆管恶性狭窄的价值及安全性。方法回顾性分析2017年8月—2022年12月长江大学附属第一医院和兰州大学第一医院诊治的104例胆管恶性狭窄患者的临床资料。104例中56例ERCP术中行推送管辅助胆道活检者为观察组,48例行SpyGlass胆道镜活检者为对照组,2组活检后均放置胆管支架或行鼻胆管引流治疗。记录2组术后48 h轻、中、重度胰腺炎及胆管炎、胆道出血、穿孔等并发症发生情况,活检组织病理结果。活检组织病理未明确诊断者术后随访6个月,综合血清肿瘤标志物检查、影像学检查、再次胆道镜活检、手术治疗等情况进行临床诊断。比较2组性别比例、年龄、合并症(高血压、糖尿病、冠心病、肝硬化)、狭窄部位、十二指肠乳头括约肌切开术(EST)比率、活检标本数量、活检总明确诊断率及肝门部、胆总管中上段、胆总管下段狭窄明确诊断率、胆管癌检出率。结果(1)观察组EST比率(69.64%)低于对照组(100.00%)(χ^(2)=15.269,P<0.001),活检标本数量[4(1,7)块]多于对照组[3(1,6)块](χ^(2)=3.325,P<0.001),年龄,性别比例,合并高血压、糖尿病、冠心病、肝硬化比率及狭窄部位与对照组比较差异均无统计学意义(P>0.05)。(2)观察组56例中47例(83.93%)活检明确诊断,对照组48例患者中42例(87.50%)活检明确诊断,2组活检总明确诊断率比较差异无统计学意义(χ^(2)=0.267,P=0.605)。观察组肝门部(76.47%)、胆总管中上段(87.50%)、胆总管下段(86.67%)狭窄明确诊断率与对照组(86.67%、94.45%、80.00%)比较差异均无统计学意义(χ^(2)=0.527,P=0.659;χ^(2)=0.562,P=0.623;χ^(2)=0.232,P=0.500)。(3)观察组临床诊断胆管癌48例中44例(91.67%)胆道活检诊断为胆管癌,对照组临床诊断胆管癌47例中42例(89.36%)胆道活检诊断为胆管癌,2组胆道活�Objective To observe the histopathological results of push-tube assisted biliary biopsy in endoscopic retrograde cholangiopancreatography(ERCP)and to investigate its value and safety in the diagnosis of malignant biliary strictures.Methods The clinical data of 104patients with malignant biliary strictures in the First Affiliated Hospital of Yangtze University and the First Hospital of Lanzhou University from August 2017 to December 2022 were retrospectively analyzed,among whom 56patients were performed ERCP push-tube assisted biliary biopsy(observation group)and 48patients were performed SpyGlass cholangioscopy biopsy(control group).After biopsy,all patients were implanted biliary stents or received nasobiliary drainage.The occurrences of complications such as mild,moderate and severe pancreatitis,cholangitis,biliary bleeding and perforation within 48hafter surgery,as well as the histopathological results of bile duct biopsy tissue were recorded in two groups.Those with no definitive diagnosis by biliary biopsy were followed up for 6 months after surgery.The clinical diagnosis was made again on the basis of serum tumor markers,imaging examinations,second cholangioscopy biopsy and surgery results.The gender ratio,age,comorbidities(hypertension,diabetes,coronary heart disease,liver cirrhosis),site of strictures,rate of endoscopic sphincterotomy(EST),number of biopsy specimens,overall definitive diagnostic rate,definitive diagnostic rates of strictures in the hepatic hilum,upper middle part of the common bile duct and lower part of the common bile duct,and the detection rate of cholangiocarcinoma were compared between two groups.Results(1)The EST rate was lower in observation group(69.64%)than that in control group(100.00%)(χ^(2)=15.269,P<0.001),the biopsy specimen was more in observation group[4(1,7)]than that in control group[3(1,6)](χ^(2)=3.325,P<0.001),and there were no significant differences in the age,gender ratio,proportions of comorbidities(hypertension,diabetes,coronary heart disease,liver cirrhosis)and

关 键 词：恶性胆道狭窄 经内镜逆行胰胆管造影术 胆道活检 SpyGlass胆道镜 推送管辅助 

分 类 号：R735.8[医药卫生—肿瘤]