摘要
目的:根据经皮肝穿胆道引流术(PTCD)过程中胆道内活检诊断恶性胆道梗阻的敏感度高低,评价胆管外肿瘤导致胆道梗阻的机理以及此项技术的临床应用价值。方法:回顾性分析连续102例因恶性阻塞性黄疸行PTCD患者的临床及影像学资料。介入手术过程中行胆道内活检,包括胆道内钳夹活检和毛刷细胞学检查,阳性结果被认为真实反映了梗阻的特性,而阴性结果不能排除肿瘤发生。27例确诊为胆道外恶性肿瘤导致胆道阻塞。通过分析胆管外恶性肿瘤导致胆道梗阻的活检敏感度差异,讨论导致胆道梗阻的病理基础以及评价胆道活检技术的临床应用价值。采用Chi-Square检验,观察活检阳性率差异,α=0.05作为检验水准。结果:本组27例胆管外恶性肿瘤导致胆道梗阻的患者,胆道内活检敏感度为88.9%,胆道内钳夹活检和刷检的敏感度分别为77.8%和74.1%,钳夹活检的阳性率高于刷检,但无显著的统计学差异(P>0.05)。胆道内活检诊断胆管外恶性肿瘤导致阻黄的敏感度与文献中诊断胆管癌的敏感度相似。结论:胆管外恶性肿瘤组织直接浸润胆管壁是导致胆道梗阻的根本原因。
Objective ：According to the sensitivity of endobiliary biopsy during PTCD, to evaluate its pathologic foundation and clinical value for extrabiliary malignant tumor. Methods ：Consecutive 102 patients with malignant obstructive jaundice were performed percu- taneous transhepatic cholangiodrainagc （PTCD）, forceps biopsy and brush cytology were manipulated during the procedure to confirm the nature of bile duct stenosis. 27 cases were confirmed as extrabiliary malignant tumor which induced bile duct stricture. All the imaging and clinical data were retrospectively analyze. The positive result of biopsy was regarded as true positive, while negative result can not exlude the existence of malignant tumor. According to the sensitivity of biopsy for malinant tumor, the pathologic foundation of bile duct stenosis was disscused and the clinical value of technique was avaluated. Chi - Square test was adopted to analyze the result of forceps biopsy and brushing, a P value of 0.05 or lexs was eonsided to indicate a significant difference. Results ： Of all 27 patients with obstructivejaundice caused by extrabiliary malignant tumor, the sensitivity of endobiliary forceps was 88.9%, similar with that in literatures. The sensitivity of endobiliary forceps biopsy and brushing was 77.8% and 74.1%, respectively, the difference was not significence（P〉0.05）. Conclusion：Infihrating throuth the wall of bile duct and into biliary lumen is the pathologic foundation for extrabiliary malignant tumor inducing bile duct stenosis.
出处
《重庆医科大学学报》
CAS
CSCD
2005年第5期728-730,共3页
Journal of Chongqing Medical University
