摘要
目的探讨PTC下胆管钳夹活组织检查（PTCB）对梗阻性黄疸的诊断价值。方法回顾性分析2001年4月至2011年12月郑州大学第一附属医院连续收治的826例接受PTCB的梗阻性黄疸患者的临床资料，统计病理学结果、PTCB阳性率及并发症等。总结PTCB的安全性、可行性及导致梗阻性黄疸的恶性肿瘤的病理学特点。PTCB对于胆道系统与非胆道系统恶性肿瘤活组织检查阳性率的差异分析采用∥检验。结果826例梗阻性黄疸患者行PTCB，成功率为100％。术后86例患者出现并发症，其中一过性胆汁血症47例，胆汁漏11例，暂时性胆道出血28例，无严重并发症发生。恶性胆管狭窄740例，良性胆管狭窄86例。PTCB阳性者727例（包括癌性狭窄641例、胆道炎性或纤维增生86例），假阴性99例，总体阳性率为88．0l％（727／826）。胆道梗阻因素中，恶性肿瘤占89．59％（740／826）。病理检查结果示高、中、低分化癌所占比例分别为57．88％（371／641）、19．97％（128／641）和22．15％（142／641），其中腺癌占96．41％（618／641）。胆道系统恶性肿瘤与非胆道系统恶性肿瘤PTCB阳性率分别为89．50％（469／524）和79．63％（172／216），两者比较，差异有统计学意义（，=12．87，P〈0．05）。结论PTCB对梗阻性黄疸病理学诊断阳性率高，临床应用安全可行。胆源性肿瘤是PTCB的最佳适应证。导致梗阻性黄疸的恶性肿瘤的主要病理类型为高分化腺癌。
Objective To investigate the value of percutaneous transhepatic cholangiobiopsy （PTCB） in the diagnosis of obstructive jaundice. Methods The clinical data of 826 patients with obstructive jaundice who received PTCB at the First Affiliated Hospital of Zhengzhou University from April 2001 to December 2011 were retrospectively analyzed. The pathological results, positive rates of PTCB and complications were analyzed. The safety and efficacy of FFCB and the pathological features of malignancy causing obstructive jaundice were summarized. The difference in the positive rates of PTCB for biliary and non-biliary malignancies was analyzed by chi-square test. Results A total of 826 patients received PTCB, and the success rate was 100%. Eighty-six patients had complications postoperatively, including transit bilhaemia in 47 patients, bile leakage in 11 patients, temporary bilimy hemorrhage in 28 patients, no severe complications occurred. There were 740 patients were with malignant biliary stricture and 86 with benign biliary stricture. Seven Hundred and twenty-seven patients were with positive results of PTCB （641 were with cancerous stricture and 86 with inflammation of biliary tract or fibrogenesis）, and 99 patients were with false negative results. The overall positive rate of PTCB was 88.01% （727/826）. Malignant neoplasm accounted for 89.59% （740/826） of the factors causing obstructive jaundice, and well-, moderate- and poor-differentiated neoplasms were accounted for 57.88% （371/641） , 19.97% （128/ 641） and 22.15% （142/641）. Biliary adenocarcinoma was the main pathologic type, which was accounted for 96.41% （618/641）. The positive rates of PTCB for biliary and non-biliary neoplasms were 89.50% （469/524） and 79.63% （ 172/216）, with significant difference （X2 = 12, 87, P 〈 0.05 ）. Conclusions PTCB is a safe,feasible and easy way to diagnose obstructive jaundice. Biliary neoplasms are the best indications for PTCB. Well differentiated neoplasm is the main pathological type c
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2013年第9期698-702,共5页
Chinese Journal of Digestive Surgery
基金
河南省卫生科技攻关项目（201003029）
