内镜逆行胰胆管造影术引导下细胞刷刷检与活检钳活检鉴别良恶性胆管狭窄的诊断效能分析  

Diagnostic efficacy of brush cytology and biopsy forceps under the guidance of endoscopic retrograde cholangiopancreatography to differentiate between benign and malignant biliary strictures

作　　者：梁正 隗永秋 张果 刘昊玺 左佳煊 李鹏[1] 张澍田[1] Liang Zheng;Wei Yongqiu;Zhang Guo;Liu Haoxi;Zuo Jiaxuan;Li Peng;Zhang Shutian(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,Beijing100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科,北京100050

出　　处：《中华消化内镜杂志》2024年第11期857-863,共7页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)引导下细胞刷刷检、活检钳活检鉴别诊断良恶性胆管狭窄的诊断效能。方法纳入2013年1月至2022年1月因不明原因胆管狭窄就诊于北京友谊医院消化内科行ERCP检查的470例患者。单次ERCP操作中先行细胞刷刷检,后根据需要行活检钳活检,诊断困难患者必要时行多次ERCP刷检或活检。回顾性收集患者的临床资料、ERCP操作情况、病理学结果、随访结果等资料。以患者的最终诊断为金标准,计算细胞刷刷检和活检钳活检的诊断效能。结果最终诊断为恶性胆管狭窄患者251例,良性胆管狭窄患者219例。470例患者均行细胞刷刷检,其中多次刷检37例;114例患者行活检钳活检。单次细胞刷刷检诊断恶性胆管狭窄的灵敏度和特异度分别为49.40%(124/251)和99.09%(217/219);多次细胞刷刷检诊断恶性胆管狭窄的灵敏度、特异度分别为68.42%(13/19)和100.00%(18/18);活检钳活检诊断恶性胆管狭窄的灵敏度、特异度分别为68.18%(45/66)、97.92%(47/48)。114例患者同时进行细胞刷刷检和活检钳活检,结果显示刷检联合活检的诊断灵敏度显著高于单次细胞刷刷检[77.27%(51/66)比43.94%(29/66),χ^(2)=13.99,P<0.001],单独活检钳活检的诊断灵敏度[68.18%(45/66)]也高于单次细胞刷刷检(χ^(2)=6.92,P=0.009)。结论ERCP引导下的两种病理标本获取方式中,联合应用细胞刷刷检和活检钳活检可以提高诊断的灵敏度,活检钳活检的诊断灵敏度优于单次细胞刷刷检。Objective To evaluate the diagnostic efficacy of brush cytology and transpapillary biopsy sampling under the guidance of endoscopic retrograde cholangiopancreatography(ERCP)in distinguishing between benign and malignant biliary strictures.Methods A total of 470 patients with unknown biliary strictures who underwent ERCP at Department of Gastroenterology,Beijing Friendship Hospital from January 2013 to January 2022 were enrolled.Brush cytology was performed before biopsy in a single procedure,and with multiple ERCP brush cytologies or biopsy performed for challenging cases.Clinical data,ERCP procedures,pathological results,and follow-up data were collected.With the final diagnosis as the golden standard,the diagnostic efficacy of brush cytology and biopsy sampling were calculated.Results The final diagnosis showed 251 cases of malignant and 219 cases of benign biliary strictures.All 470 patients received brush cytology,among whom,37 patients underwent multiple brush cytologies.Additionally,114 patients were treated with biopsy sampling.The single brush cytology showed a sensitivity of 49.40%(124/251)and a specificity of 99.09%(217/219)for diagnosing malignant biliary strictures.Multiple brush cytologies showed a sensitivity of 68.42%(13/19)and a specificity of 100.00%(18/18).Biopsy sampling showed a sensitivity of 68.18%(45/66)and a specificity of 97.92%(47/48).Among the 114 patients who underwent both brush cytology and biopsy sampling,the results showed that the diagnostic sensitivity of brush cytology combined with biopsy sampling[77.27%(51/66)]and the sensitivity of single biopsy sampling[68.18%(45/66)]were significantly higher than that of single brush cytology[43.94%(29/66),χ^(2)=13.99,P<0.001;χ^(2)=6.92,P=0.009].Conclusion Combining brush cytology and biopsy forceps during ERCP enhances diagnostic sensitivity in identifying malignant biliary strictures.Biopsy sampling stands out as more sensitive compared with single brush cytology,emphasizing its role in improving diagnostic capabilities.

关 键 词：胰胆管造影术 内窥镜逆行 不明原因胆管狭窄 细胞刷刷检 活检钳活检 

分 类 号：R735.8[医药卫生—肿瘤]