内镜逆行胰胆管造影术非直视下活体组织检查在胆管良恶性狭窄鉴别诊断中的应用  

The application of non-direct vision biopsy under endoscopic retrograde cholangiopancreatography in the differential diagnosis of benign and malignant biliary strictures

作　　者：朱峰毅 许小兵 邱新运 马晶晶[1] 肖璇[2] 倪金良[1] 陈晓星[1] 程文芳[1] 张国新[1] 徐顺福[1] Zhu Fengyi;Xu Xiaobing;Qiu Xinyun;Ma Jingjing;Xiao Xuan;Ni Jinliang;Chen Xiaoxing;Cheng Wenfang;Zhang Guoxin;Xu Shunfu(Department of Gastroenterology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Pathology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院消化内科,南京210029 [2]南京医科大学第一附属医院病理科,南京210029

出　　处：《中华消化杂志》2024年第3期165-171,共7页Chinese Journal of Digestion

摘　　要：目的探讨经内镜逆行胰胆管造影术(ERCP)非直视下活体组织检查(以下简称活检)在鉴别胆管良恶性狭窄中的应用价值。方法回顾性选择2017年1月14日至2022年6月2日于南京医科大学第一附属医院行ERCP非直视下活检的194例胆管狭窄患者。根据病理结果诊断为阳性(恶性)、阴性(良性)、可疑(不确定),可疑类别进一步分为非典型和可疑恶性。运用Kappa一致性分析和卡方检验比较ERCP非直视下活检、胆管细胞刷检,以及同时接受ERCP非直视下活检和胆管细胞刷检的诊断一致性。运用二分类logistic回归模型比较非典型与可疑恶性的RR值。结果共189例患者行ERCP非直视下活检,活检结果阳性88例、可疑30例、阴性71例,可疑分类中非典型23例、可疑恶性7例。共148例患者同时接受ERCP非直视下活检和胆管细胞刷检,胆管细胞刷检结果阳性18例,可疑69例、阴性61例,可疑分类中非典型43例、可疑恶性26例。Kappa检验结果显示,ERCP非直视下活检与胆管细胞刷检的诊断结果一致性较差(Kappa值=0.267,P<0.001);ERCP非直视下活检诊断胆管恶性狭窄的灵敏度高于胆管细胞刷检[76.1%(67/88)比21.6%(19/88)],差异有统计学意义(χ2=53.39,P<0.001),而特异度比较[81.7%(49/60)比78.3%(47/60)],差异无统计学意义(P>0.05)。ERCP非直视下活检与同时接受ERCP非直视下活检和胆管细胞刷检诊断一致性较好(Kappa值=0.821,P<0.001),后者诊断胆管恶性狭窄的灵敏度为79.5%(70/88),特异度为86.7%(52/60),与ERCP非直视下活检比较,差异均无统计学意义(均P>0.05)。对于ERCP非直视下活检,活检标本数>3块诊断胆管恶性狭窄的灵敏度、阳性预测值和准确度均高于活检标本数≤3块(85.1%比67.6%、96.1%比78.6%、86.5%比75.3%),差异均有统计学意义(χ2=4.63、9.05、3.92,P=0.031、0.003、0.048)。胆管上中段与胆管下段部位活检诊断胆管恶性狭窄的灵敏度、特异度、阳性预测值、阴�Objective To explore the application value of non-direct vision biopsy under endoscopic retrograde cholangiopancreatography(ERCP)in the differential diagnosis of benign and malignant biliary strictures.Methods From January 14,2017 to June 2,2022,at the First Affiliated Hospital of Nanjing Medical University,194 patients with biliary strictures who received ERCP were retrospective selected.According to the pathological results,the diagnosis was positive(malignant),negative(benign),the suspicious(uncertain),and the suspicious was further divided into atypical and suspected malignant.Kappa consistency analysis and chi-square test were used to compare the diagnostic consistency of non-direct vision biopsy under ERCP,bile duct brushing,and simultaneous non-direct vision biopsy under ERCP and bile duct brushing.Binary logistic regression model was used to compare the relative malignant risk ratios of atypical and suspected malignant.Results A total of 189 patients successfully received non-direct vision biopsy under ERCP,the biopsy results of 88 cases were positive,30 cases were suspicious,and 71 cases was negative.Among the suspicious cases,23 cases were atypical and 7 cases were suspected malignant.A total of 148 patients underwent non-direct vision biopsy under ERCP and bile duct brushing simultaneously,the biopsy results of 18 cases were positive,69 cases were suspicious,and 61 cases were negative.Among the suspicious cases,43 cases were atypical,and 26 cases were suspected malignant.The results of Kappa test showed that the diagnostic consistency between non-direct vision biopsy under ERCP and bile duct brushing was poor(Kappa value=0.267,P<0.001).The sensitivity of non-direct vision biopsy under ERCP was higher than that of bile duct brushing in the diagnosis of malignant biliary strictures(76.1%,67/88 vs.21.6%,19/88),and the difference was statistically significant(χ2=53.39,P<0.001),while there was no significant difference in the differential diagnosis of specificity(81.7%,49/60 vs.78.3%,47/60,P>0.05).The diag

关 键 词：非直视下活检 胆管狭窄 细胞刷检 非典型诊断 超细活检钳 诊断灵敏度 

分 类 号：R575.7[医药卫生—消化系统]