经ERCP联合SpyGlass DS治疗的74例不明原因胆管狭窄患者的临床特征分析  

Clinical characteristics of 74 patients with indeterminate biliary stricture treated by ERCP combined with SpyGlass DS

作　　者：马丽娜·阿新拜 张立平[1,3] 王林恒[3] 王允亮[3] 陈润花[3] 孟捷[3] 胡立明[3] 姚玉璞[3] MALINA·Axinbai;ZHANG Liping;WANG Linheng;WANG Yunliang;CHEN Runhua;MENG Jie;HU Liming;YAO Yupu(Beijing University of Chinese Medicine,Beijing 100029;School of Traditional Chinese Medicine,Xinjiang Medical University;Department of Spleen,Stomach,Liver and Gallbladder,Dongfang Hospital,Beijing University of Chinese Medicine,China)

机构地区：[1]北京中医药大学,北京100029 [2]新疆医科大学中医学院 [3]北京中医药大学东方医院脾胃肝胆科

出　　处：《胃肠病学和肝病学杂志》2024年第8期1037-1044,共8页Chinese Journal of Gastroenterology and Hepatology

基　　金：北京中医药大学重点攻关项目(2020-JYB-ZDGG-132)。

摘　　要：目的 分析经内镜逆行胰胆道造影(endoscopic retrograde cholangiopancreatography, ERCP)联合SpyGlass DS治疗的不明原因胆管狭窄(indeterminate biliary stricture, IBS)患者的临床资料,为IBS的诊疗提供更多临床数据参考。方法 回顾性分析2020年1月至2023年4月北京中医药大学东方医院消化内镜中心经ERCP联合SpyGlass DS治疗的74例IBS患者的临床资料,归纳采用SpyGlass DS直视下视觉印象评估良恶性狭窄的情况,总结SpyGlass DS引导下视觉印象和SpyGlass DS引导下活检(SpyBite活检)在诊断IBS的性能特点。结果 共纳入74例IBS患者,男49例,女25例,年龄(67±12)岁(26~94岁)。74例患者中,61例(82.4%)直视下考虑为恶性狭窄,其中40例(65.6%)病理诊断提示恶性,5例(8.2%)病理诊断未提示恶性,16例(26.2%)未取活检。随访过程中,有1例患者经影像学检查被诊断为恶性肿瘤,而其余患者未发现进展;13例(17.6%)SpyGlass DS直视下考虑为良性狭窄,其中3例(23.0%)病理诊断恶性,5例(38.5%)病理诊断未提示恶性,5例(38.5%)未取活检并在随访过程中均未发现狭窄处进展。SpyGlass DS直视下视觉印象为肿瘤血管、增生物、黏膜不规则/结节性/增生性改变、黏膜损伤、胆管内渗出物的表现而病理诊断提示恶性的占比分别为24.4%、20.0%、62.2%、2.2%、8.9%。SpyGlass DS直视下视觉印象的敏感度为88.9%,特异度为37.5%,准确度为81.1%,SpyBite活检的诊断敏感度为95.7%,特异度为66.7%,准确度为92.3%。结论 对IBS可采用ERCP联合SpyGlass DS进行诊断,可大大提高疾病确诊率。Objective To analyze the clinical data of patients with indeterminate biliary stricture(IBS)treated by endoscopic retrograde cholangiopancreatography(ERCP)combined with SpyGlass DS to provide more clinical data reference for the treatment of IBS.Methods To review the clinical data of 74 patients with IBS treated by ERCP combined with SpyGlass DS at the Digestive Endoscopy Center of Dongfang Hospital,Beijing University of Chinese Medicine from Jan.2020 to Apr.2023,analyze the clinical characteristics of patients,summarize the assessment of benign and malignant strictures using SpyGlass DS direct visual impression,and summarize the results of SpyGlass DS-guided visual impression and SpyGlass DS-guided biopsy(SpyBite biopsy)performance characteristics in the diagnosis of IBS.Results A total of 74 patients with IBS,including 49 males and 25 females,aged(67±12)years(26-94 years),were included in this study.Sixty-one(82.4%)of the 74 patients were considered to have malignant stenosis under direct visualization,of which 40(65.6%)had a pathological diagnosis suggestive of malignancy,5(8.2%)had a pathological diagnosis not suggestive of malignancy,and 16(26.2%)were not undergo biopsy.During follow-up,1 patient was diagnosed as malignant by imaging,while no progression was detected in the remaining patients.Thirteen(17.6%)SpyGlass DS stenoses were considered benign under direct visualization,of which 3(23.0%)were pathologically diagnosed as malignant,5(38.5%)were not pathologically diagnosed as malignant,and 5(38.5%)were not biopsied and no progression was detected in any of the stenoses during follow-up.The percentage of SpyGlass DS direct visual impressions of tumor vascularity,hyperplasia,mucosal irregularity/nodular/proliferative changes,mucosal injury and biliary exudate with pathological diagnosis suggestive of malignancy were 24.4%,20.0%,62.2%,2.2%and 8.9%,respectively.The diagnostic sensitivity of SpyGlass DS direct visual impressions was 88.9%,with a specificity of 37.5%and accuracy of 81.1%,and the diagnostic se

关 键 词：不明原因胆管狭窄 ERCP SpyGlass DS 视觉印象 SpyBite直视活检 

分 类 号：R575.7[医药卫生—消化系统]