Comparative studies of DU-PAN-2, carcinoembryonic antigen, and CA19-9 in the serum and bile of patients with pancreatic and biliary tract diseases: evaluation of the influence of obstructive jaundice

The levels of DU-PAN-2 antigen, carcinoembryonic antigen, and CA19-9 in serum and bile of patients with pancreatic and biliary tract diseases were measured. The sensitivities (true positive) of DU-PAN-2 in serum to pancreatic carcinoma (64%) and to biliary tract carcinoma (62%) were similar to those of CA19-9 in serum (69% and 72%, respectively). Nine of 18 (50%) patients with CA19-9-negative pancreatic carcinoma tested positive for DU-PAN-2. The sensitivities of CEA to pancreatic carcinoma (56%) and to biliary tract carcinoma (52%) were lowest. The measurement of these antigens in bile seemed to be of little diagnostic value in differentiating between malignant and benign diseases. False positives of these three assays occurred frequently in patients with benign pancreatic or biliary tract disease coupled with obstructive jaundice. After percutaneous transhepatic biliary drainage, serum DU-PAN-2 and CA19-9 levels returned to normal ranges in patients with benign diseases, but not in patients with carcinoma of the pancreas or of the biliary tract. Serum CA19-9 and DU-PAN-2 antigens are useful tumor markers for pancreatic and biliary tract carcinomas. Longitudinal assays of these antigens may be useful for the differential diagnosis of patients with obstructive jaundice.     

A case of common bile duct stone with cholangitis presenting an extraordinarily high serum CA19-9 value.

A 63-year-old male complained of right upper abdominal pain and jaundice. Laboratory data on admission showed hyperbilirubinemia, elevation of biliary enzymes and an extraordinarily high value of serum CA19-9 (60,000 U/ml). Diagnostic imaging modalities including abdominal ultrasonogram, abdominal CT and PTC suggested a stone impaction of the common bile duct. Jaundice subsided after PTC-drainage in association with decreasing serum CA19-9 value, which returned to the normal level six weeks later. Spontaneous delivery of the stone via the fistula was confirmed by cholangiography through the drainage tube. Though there are few reports of such a high serum CA19-9 level, the possibility of benign biliary tract disease should be considered in patients showing an extraordinarily high serum CA19-9 value.     

Differentiation between benign and malignant hilar obstructions using laboratory and radiological investigations: a prospective study

Background: Preoperative determination of the aetiology of bile duct strictures at the hilum is difficult. We evaluated the diagnostic accuracy of laboratory parameters and imaging modalities in differentiating between benign and malignant causes of hilar biliary obstruction. Patients and methods: Fifty-eight patients (26 men) with a history of obstructive jaundice and liver function tests (LFTs) and ultrasound suggestive of biliary obstruction at the hilum were studied. They were evaluated by tumour marker assay (CA19–9), CT and MRI/MRCP. A single experienced radiologist, blinded to the results of other tests, evaluated the imaging. The final diagnosis was made either from histology of the resected specimen, operative findings or image-guided biopsy in inoperable patients. A receiver operator characteristic (ROC) curve was constructed for each laboratory parameter to determine optimal diagnostic cut-off to predict malignant biliary stricture (MBS). Results: In all, 34 patients had a benign and 24 had malignant aetiology. The mean age of benign patients was 38 years compared with 54 years for MBS. Forty-seven patients were treated with surgery while 11 had ERCP/PTC and stenting. The ROC curve showed that preoperative bilirubin level >8.4 mg/dl (sensitivity 83.3%, specificity 70%), alkaline phosphatase level >478 IU (sensitivity 63%, specificity 49%) and CA19–9 levels >100 U/L (sensitivity 45.8%, specificity 88.2%) for predicting MBS. The sensitivity, specificity and diagnostic accuracy of MRI/MRCP (87.5%, 85.3%, 82.7%, respectively) was marginally superior to CT (79.2%, 79.4%, 79.3%, respectively). Conclusions: Patients with a bilirubin level of >8.4 mg% and CA19–9 level >100 U/L were more likely to have malignant aetiology. MRI/MRCP was a better imaging modality than CT.     

Type 2 diabetes mellitus and CA 19-9 levels

AIM： To prospectively investigate serum CA 19-9 levels in type 2 diabetic patients in comparison with age and gender-matched control subjects.
METHODS： We recorded duration of diabetes and examined fasting glucose levels, HbAlc levels and serum CA 19-9 levels in 76 type 2 diabetic patients and 76 controls. Abdominal CT was performed in order to eliminate abdominal malignancy in the diabetic and control groups.
RESULTS： The average CA 19-9 level was 46.0 ± 22.4 U/mL for diabetic patients whereas it was 9.97± 7.1 U/mL for the control group （P 〈 0.001 ）. Regression analysis showed a positive correlation between diabetes and CA 19-9 independent from age, gender, glucose level and HbAlc level （t = 8.8, P 〈 001 ）. Two of the diabetic patients were excluded from the study because of abdominal malignancy shown by CT at the initial evaluation. For all patients, abdominal CT showed no pancreatic abnormalities.
CONCLUSION： CA 19-9 is a tumor-associated antigen, which is elevated in pancreatic, upper gastrointestinal tract, ovarian hepatocellular, and colorectal cancers, as well as in inflammatory conditions of the hepatobiliary system, biliary obstruction and in thyroid diseases. Diabetes has been claimed to be a risk factor for pancreatic cancer, which is increasing its incidence and has one of the lowest survival rates of all cancers. CA 19-9 is used in the diagnosis of pancreatic cancer but is also a marker of pancreatic tissue damage that might be caused by diabetes. We propose that a higher cutoff value of CA 19-9 should be used in diabetics to differentiate benign and malignant pancreatic disease, and subtle elevations of CA 19-9 in diabetics should be considered as the indication of exocrine pancreatic dysfunction.     

Adjusting CA19-9 values to predict malignancy in obstructive jaundice: influence of bilirubin and C-reactive protein

AIM: To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice (BJ) and malignant jaundice (MJ).METHODS: All patients admitted for obstructive jaundice, in the period 2005-2009, were prospectively enrolled in the study, obtaining a total of 102 patients. On admission, all patients underwent complete standard blood test examinations including C-reactive protein (CRP), bilirubin, CA19-9. Patients were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels (total bilirubin > 2.0 mg/dL). The standard cut-off level for CA19-9 was 32 U/mL, whereas for CRP this was 1.5 mg/L. The CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP value. The patients were divided into 2 groups, MJ and BJ, and after the adjustment a comparison between the 2 groups of patients was performed. Sensitivity, specificity and positive predictive values were calculated before and after the adjustment.RESULTS: Of the 102 patients, 51 were affected by BJ and 51 by MJ. Pathologic CA19-9 levels were found in 71.7% of the patients. In the group of 51 BJ patients there were 29 (56.9%) males and 22 (43.1%) females with a median age of 66 years (range 24-96 years), whereas in the MJ group there were 24 (47%) males and 27 (53%) females, with a mean age of 70 years (range 30-92 years). Pathologic CA19-9 serum level was found in 82.3% of MJ. CRP levels were pathologic in 66.6% of the patients with BJ and in 49% with MJ. Bilirubin and CA19-9 average levels were significantly higher in MJ compared with BJ (P = 0.000 and P = 0.02), while the CRP level was significantly higher in BJ (P = 0.000). Considering a CA19-9 cut-off level of 32 U/mL, 82.3% in the MJ group and 54.9% in the BJ group were positive for CA19-9 (P = 0.002). A CA19-9 cut-off of 100 U/mL increases the difference between the two groups: 35.3% in BJ and 68.6% in MJ (P = 0.0007). Adjusting the CA19-9 value by dividing it by serum bilirubin level meant that 21.5% in the BJ and 49% in the MJ group remained with a positive CA19-9 value (P = 0.003), while adjusting the CA19-9 value by dividing it by serum CRP value meant that 31.4% in the BJ group and 76.5% in the MJ group still had a positive CA19-9 value (P = 0.000004). Sensitivity, specificity, positive predictive values of CA19-9 > 32 U/mL were 82.3%, 45% and 59.1%; when the cut-off was CA19-9 > 100 U/mL they were, respectively, 68.6%, 64.7% and 66%. When the CA19-9 value was adjusted by dividing it by the bilirubin or CRP values, these became 49%, 78.4%, 69.4% and 76.5%, 68.6%, 70.9%, respectively.CONCLUSION: The present study proposes CRP as a new and useful correction factor to improve the diagnostic value of the CA19-9 tumor marker in patients with cholestatic jaundice.     

良、恶性阻塞性黄疸患者梗阻解除后肝功能变化的比较

目的比较良、恶性阻塞性黄疸患者胆道梗阻解除后的肝功能变化。方法对胆总管结石所致阻塞性黄疸患者(24例)行EST-ENBD治疗。胆管及壶腹部恶性肿瘤患者(20例)行PTCD胆管支架及内外引流术解除梗阻。检测比较患者术前1～3d及术后3d和7d的有关生化指标,包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、总胆红素(TBIL)、直接胆红素(DBIL)及胆汁酸(TBA)。结果(1)ENBD和PTCD两种方法整体上都可有效解除梗阻,通畅引流胆汁,减轻或消退黄疸(7d时两组TBIL分别下降约63%和33%)。与治疗前相比,随着梗阻的解降,各项肝功能指标亦逐步下降。(2)与梗阻解除前相比,两组患者治疗后ALT、AST及TBA均显著下降(P0.05)。良性梗阻组ENBD治疗前后TBIL、DBIL有显著差异(P0.01)。恶性梗阻组治疗后TBIL、DBIL数值较治疗前下降,但无统计学意义(P0.05)。结论对于良性阻塞性黄疸,EST/ENBD可有效解降梗阻,减轻黄疸,促进肝功能的恢复。而恶性阻塞性黄疸,PTCD胆管支架及内外引流术可以解除梗阻,通畅引流,促进转氨酶下降,但黄疸消退效果欠佳,可能有胆汁淤积等其它因素参与黄疸形成。TBA为反映胆道梗阻状态的较好指标。     

Utility of serum CA19-9 in diagnosis of cholangiocarcinoma： In comparison with CEA

AIM:The diagnosis of cholangiocarcinoma is often difficult,making management approaches problematic. A reliable serum marker for cholangiocarcinoma would be a useful diagnostic test. The aims of our study were to evaluate the usefulness of a serum CA19-9 determination in the diagnosis of cholangiocarcinoma.METHODS: We prospectively measured serum CA19-9 and CEA concentrations in patients with cholangiocarcinoma (n=35), benign biliary diseases (n=92), and healthy individuals (n=15). Serum CA19-9 and CEA concentrations were measured by an immunoradiometric assay without knowledge of the clinical diagnosis.RESULTS:The sensitivity of a CA19-9 value>37KU·L^-1 and a CEA value >22μg·L^-1 in diagnosing cholangiocarcinoma were 77.14% and 68.57%, respectively. When compared with the benign biliary diseases group,the true negative rates of serum CA19-9 and CEA were 84.78% and 81.52%,respectively. The false positive rates of serum CA19-9 and CEA were 15.22% and 18.48%, whereas the accuracy of serum CA19-9 and CEA were 82.68% and 77.95%,respectively. Serum CA19-9 and CEA concentrations were significantly elevated (P<0.001 and P<0.05) in patients with cholangiocarcinoma (290.31±5.34KU·L^-1 and 36.46±18.03μg·L^-1) compared with patients with benign biliary diseases (13.38±2.59KU·L^-1 and 13.84±3.85μg·L^-1) and healthy individuals (12.78±3.69KU·L^-1 and 11.48±3.37μg·L^-1). In 15 patients undergoing curative resection of cholangiocarcinoma,the mean serum CA19-9 concentration was decreased from a preoperative level of 286.41±4.36KU·L^-1 to a postoperative level of 62.01±17.43KU·L^-1 (P<0.001), and the mean serum CEA concentration from 39.41±24.35μg·L^-1 to 28.69±11.03μg·L6-1(P<0.05). In patients with cholangiocarcinoma,however, no correlation was found between serum CEA and CA19-9 concentrations (r=-0.036).CONCLUSION:These data suggest that the serum CA19-9 determination is a useful addition to the available tests for the differential diagnosis of cholangiocarcinoma. Serum CA19-9 is an effective tumor marker in diagnosing cholangiocarcinoma,deciding whether the tumor has been radically resected and monitoring effect of treatment.     

High CA 19-9 levels in benign biliary tract diseases. Report of four cases and review of the literature

For years, CA 19-9 has been proposed as a marker for epithelial-type gastrointestinal cancers, even though it is well known that its diagnostic specificity is low. Here we describe cases of extremely high CA 19-9 levels in benign biliary tract diseases. The first case involved a 77-year-old male patient with choledocholithiasis and jaundice who was found to have CA 19-9 levels of 98,628 UI/ml. The second case was a 63-year-old male patient with autoimmune cholangitis and a CA 19-9 level of 250 IU/ml. The third case was a 74-year-old male patient with cholelithiasis and choledocholithiasis who developed acute cholangitis. CA 19-9 levels were elevated to 14,950 UI/ml during the episode. The fourth case involved a 73-year-old man with biliary colic and jaundice following an acute open cholecystectomy procedure who had a transient 100-fold increase in CA 19-9 (2230 IU/ml).     

胆汁和血清KL-6黏蛋白在良恶性梗阻性黄疸中的表达及临床意义

目的探讨良恶性梗阻性黄疸患者血清和胆汁KL-6黏蛋白的表达差异及其在良恶性梗阻性黄疸鉴别诊断中的临床应用价值。方法采集41例确诊的恶性梗阻性黄疸患者（恶性梗阻组）和15例确诊的良性梗阻性黄疸患者（良性梗阻组）的胆汁和血清样本,酶联免疫法检测胆汁和血清KL-6黏蛋白水平,放射免疫法测定血清AFP、CEA和CA19-9水平,对各检测指标组间间表达差异以及鉴别诊断良恶性梗阻性黄疸的效能行统计学分析。结果血清CEA、CA19-9、KL-6黏蛋白及胆汁KL-6黏蛋白在恶性梗阻组中的表达水平显著高于良性梗阻组,差异均有统计学意义（P〈0．01）;而血清AFP的表达水平在两组间差异无统计学意义（P=0．302）。血清AFP、CEA、CA19-9、KL-6黏蛋白及胆汁KL-6黏蛋白的ROC曲线下面积分别为0．657、0．753、0．894、0．846和0．954,以各检测指标的最佳临界值为界,胆汁KL-6黏蛋白鉴别诊断良恶性梗阻性黄疸的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比均优于血清AFP、CEA、CA19-9和KL-6黏蛋白。结论胆汁KL-6黏蛋白对鉴别良恶性梗阻性黄疸具有一定的临床应用价值,有望成为鉴别诊断良恶性梗阻性黄疸的特异性肿瘤标记物。     

Percutaneous transhepatic drainage of the biliary tract: technique and results in 104 cases.

A two-step procedure for percutaneous transhepatic drainage (PTD) of the biliary tract is described. This technique was applied on a total of 105 cases of obstructive jaundice, 84 with malignant and 21 with benign lesions, and was successful in 104. Decompression effect was adequate and reduction in serum bilirubin level was quick. Operative mortality, which used to be high in jaundiced patients with serum bilirubin levels above 10 mg per dl, has been significantly reduced with this procedure employed as the first step in a two-stage operation for malignant biliary obstruction. PTD proved to be very useful in the management of acute obstructive suppurative cholangitis and ensuing liver abscesses. Continuous drainage was also achieved by PTD in inoperable cases, and 1 patient with a hilar carcinoma was kept alive for 2 years and 1 month by PTD alone. With the improvement in the diagnosis of biliary tract disease this procedure will assume an important position in the management of obstructive jaundice.     

血清CA199对良恶性胆道疾病的意义

目的 探讨血清CA199在良恶性胆道疾病中表达的意义.方法 回顾性分析我院消化内科2010～2012年188例胆总管结石患者和49例肝外胆管癌伴阻塞性黄疸患者的住院病历资料,采用SPSS 1统计软件分析各患者血清CA199、肝功能等指标.结果 ①188例胆总管结石患者血清CA199阳性率达43.6％,阳性患者中CA199在37～ 200U/ml例数最多;49例肝外胆管癌患者血清CA199阳性率达91.8％,明显高于良性胆道疾病,差异有统计学意义（x2=16.94,P=0.00）;②胆总管结石伴阻塞性黄疸和肝外胆管癌患者不同血清胆红素水平的血清CA199表达水平有显著差异（P＜0.05）,血清CA199与总胆红素有密切的相关性,少数胆总管结石伴阻塞性黄疸患者血清CA199升高显著,但良恶性阻塞性黄疸患者之间血清CA199仍有显著性差异.③胆总管结石伴阻塞性黄疸患者经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）治疗后2周,血清CA199、血清总胆红素较术前明显下降,差异有统计学意义（P＜0.05）.结论 血清CA199不仅可以运用于胆道恶性肿瘤的辅助诊断,也可以作为部分良性胆道疾病患者临床疗效的辅助观察指标之一.     

Type 2 diabetes mellitus and CA 19-9 levels

AIM: To prospectively investigate serum CA 19-9 levels in type 2 diabetic patients in comparison with age- and gender-matched control subjects. METHODS: We recorded duration of diabetes and examined fasting glucose levels, HbA1c levels and serum CA 19-9 levels in 76 type 2 diabetic patients and 76 controls. Abdominal CT was performed in order to eliminate abdominal malignancy in the diabetic and control groups. RESULTS: The average CA 19-9 level was 46.0 ± 22.4 U/mL for diabetic patients whereas it was 9.97 ± 7.1 U/mL for the control group (P ＜ 0.001 ). Regression analysis showed a positive correlation between diabetes and CA 19-9 independent from age, gender, glucose level and HbA1c level (t = 8.8, P ＜ 001 ). Two of the diabetic patients were excluded from the study because of abdominal malignancy shown by CT at the initial evaluation. For all patients, abdominal CT showed no pancreatic abnormalities. CONCLUSION: CA 19-9 is a tumor-associated antigen, which is elevated in pancreatic, upper gastrointestinal tract, ovarian hepatocellular, and colorectal cancers, as well as in inflammatory conditions of the hepatobiliary system, biliary obstruction and in thyroid diseases. Diabetes has been claimed to be a risk factor for pancreatic cancer, which is increasing its incidence and has one of the lowest survival rates of all cancers. CA 19-9 is used in the diagnosis of pancreatic cancer but is also a marker of pancreatic tissue damage that might be caused by diabetes. We propose that a higher cutoff value of CA 19-9 should be used in diabetics to differentiate benign and malignant pancreatic disease, and subtle elevations of CA 19-9 in diabetics should be considered as the indication of exocrine pancreatic dysfunction.     

Perioperative hepatic functional risk assessed with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin liver scintigraphy in patients undergoing pancreaticoduodenectomy complicated by obstructive jaundice.

CONCLUSION: Liver scintigraphy with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin (Tc-GSA) can be used to predict outcome of biliary drainage and hepatic function after pancreaticoduodenectomy in patients with pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice. BACKGROUND: Preoperative obstructive jaundice has been reported as a crucial risk factor for serious postoperative complications in patients undergoing pancreaticoduodenectomy. The aim of the present study was to investigate whether Tc-GSA liver scintigraphy can assess hepatic functional risk in patients with pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice. METHODS: Liver scintigraphy was performed before biliary drainage in 18 patients with obstructive jaundice. The maximum removal rate of Tc-GSA (GSA-Rmax; standard normal value > or = 0.60) was calculated. These patients underwent pancreaticoduodenectomy with wide lymphadenectomy. The efficacy of preoperative biliary drainage was assessed with the decrease in serum bilirubin concentration in the first week after biliary drainage. Postoperative liver function was assessed with the increase in serum bilirubin concentration, which was the difference between the immediate preoperative and maximal postoperative bilirubin concentrations. RESULTS: Serum bilirubin decreased more in the first week after biliary drainage in patients with GSA-Rmax > or = 0.60 (7.64 +/- 1.09 mg/Dl/wk) than in patients with GSA-Rmax < 0.60 (3.56 +/- 1.25 mg/DL/wk, p = 0.042). Postoperative bilirubin increased less in patients with GSA-Rmax > or = 0.60 (0.81 +/- 0.30 mg/dL) than in patients with GSA-Rmax < 0.60 (4.00 +/- 0.69 mg/DL, p = 0.0012). Multivariate analysis showed that GSA-Rmax significantly predicted the postoperative bilirubin increase (p = 0.020).     

Dilemma of elevated CA 19-9 in biliary pathology

Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker which has been extensively evaluated and widely utilized primarily in diagnosing and prognosticating pancreaticobiliary malignancies. Levels may be significantly influenced and elevated in cases of benign biliary conditions however, especially in obstructive jaundice, thereby posing difficulty in distinguishing between benign and malignant cholestasis. A myriad of studies have focused on elucidating proper use and interpretation of CA 19-9 in pancreatic cancer as well as in the setting of cholestasis. These studies have demonstrated that many factors influence CA 19-9 values and various methods for interpreting CA 19-9 in obstructive jaundice have been proposed. With improvements in diagnostic imaging, advancements in endoscopic modalities, and likelihood that management will not change based on the results of the test, clinicians should be cautious when ordering CA 19-9 and consider the reasons for measuring the tumor marker.     

胆汁肿瘤标志物检测对于胆管远端良恶性狭窄鉴别诊断的价值

目的 探讨ERCP中胆汁肿瘤标志物的检测对于胆管远端良恶性狭窄鉴别诊断的价值.方法 对经手术或病理学确诊的20例胆管远端恶性狭窄,30例胆管远端良性狭窄患者及13例非胆胰疾病志愿者在ERCP或PTC时提取胆汁,采用免疫放射分析法(IRMA)检测胆汁和血清的CA19-9,CEA,AFP含量,评价其诊断价值.结果 当界定值...     

Serum endothelin-1 and hepatocyte growth factor levels in patients with obstructive jaundice.

BACKGROUND/AIMS: Endothelin-1, a potent vasoconstrictive peptide, is known to modulate changes in local circulation. Additionally, hepatocyte growth factor, a potent mitogen for hepatocytes, is increased in various liver diseases. The present study examined changes in serum endothelin-1 and hepatocyte growth factor levels in patients with obstructive jaundice before and after percutaneous transhepatic cholangio drainage. METHODOLOGY: Endothelin-1 and hepatocyte growth factor levels were measured by enzyme-linked immunosorbent assay using sera from 16 patients with obstructive jaundice before and after percutaneous transhepatic cholangio drainage. RESULTS: Serum endothelin-1 levels decreased rapidly in the good bilirubin decrease group after biliary drainage. Endothelin-1 levels decreased 1 week after drainage but then increased gradually in the worse bilirubin decrease group. Serum hepatocyte growth factor levels decreased gradually after biliary drainage, and were higher in the worse bilirubin decrease group than in the good bilirubin decrease group throughout the study. CONCLUSIONS: These results suggest that endothelin-1 may be associated with the microcirculatory disturbance in obstructive jaundice and prolonged cholestasis. Measurement of hepatocyte growth factor levels in patients with obstructive jaundice before percutaneous transhepatic cholangio drainage may be an early clinical predictor of the subsequent rate of decrease of the serum bilirubin concentration.     

超声内镜引导下胆汁引流治疗ERCP治疗失败的恶性梗阻性黄疸患者疗效初步研究

目的 探讨采用超声内镜引导下胆汁引流术(EUS-BD)和经皮肝胆管引流术(PTBD)再治疗经内镜逆行胰胆管造影术(ERCP)治疗失败的恶性梗阻性黄疸患者的有效性及安全性。方法 2013年1月～2018年12月我院收治的经ERCP治疗失败的恶性梗阻性黄疸患者75例,术前经B超、CT或MRCP等影像学检查证实存在恶性胆管梗阻,其中胰腺癌15例、壶腹部癌12例、胆管癌27例、胆囊癌9例、胃肠道恶性肿瘤侵犯11例和非霍奇金淋巴瘤1例。其中40例接受EUS-BD治疗,35例接受PTBD治疗。结果 在40例EUS-BD治疗患者中,采用超声内镜引导下对接技术完成治疗16例(40.0%),在超声内镜引导下顺行技术完成治疗24例(60.0%),其中37例(92.5%)操作成功,在35例PTBD治疗患者中,28例(80.0%)操作成功,EUS-BD治疗患者操作时间为治疗后,EUS-BD治疗患者血清总胆红素水平为(138.7±50.2)μmol/L,显著低于PTBD治疗患者的(162.4±60.2)μmol/L,而血清白蛋白水平为(34.8±3.7)g/L,显著高于PTBD治疗患者的(32.1±4.6)g/L,P<0.05];EUS-BD治疗患者术后并发症发生率为7.5%(3/40),其中胆道出血2例(5.0%),急性胆管炎1例(2.5%),PTBD治疗患者术后并发症发生率为22.9%(8/35,P<0.05),其中胆道出血3例(8.6%),肝包膜下出血1例(2.9%),胆汁性腹膜炎1例(2.9%),胆漏1例(2.9%),胆道感染2例(5.7%)。结论 在ERCP治疗失败的恶性胆道梗阻患者,可选择EUS-BD或PTBD进行补救治疗,或许可消退黄疸,暂时减轻病情。     

The biological aftereffects of preoperative and palliative percutaneous biliary drainage]

Biological repercussions in 78 patients with malignant obstructive jaundice in whom percutaneous biliary drainage was performed, are reported. In 37 cases drainage was done during operation while 41 were palliative. Biochemistry, proteinogram, hematological studies, renal function and immunology were assessed 15.7 +/- 3.4 days postoperatively and 25.2 +/- 4.7 days in palliative drainage. Results show a significant improvement of all parameters, more important in preoperative drainages especially in those combining percutaneous and internal drainage techniques.     

探讨胆汁肿瘤标志物对胆管良恶性疾病的诊断价值

目的探讨胆汁肿瘤标志物对胆管良恶性疾病的诊断价值。方法160例因胆道疾病需要ERCP治疗者,ERCP时取胆汁检测胆汁肿瘤标志物（CA19-9、CEA和CA242）和细菌培养。结果恶性狭窄组与良性疾病组间胆汁和血清CA19-9、CEA、CA242水平差异均有统计学意义（P〈0．05）;根据ROC曲线制定恶性狭窄的胆汁肿瘤标志物界限值：CA19-9239ku／L,CEA40ng／ml,CA24260ku／ml。CEA敏感度、准确度、阴性预测值与血液标志物比较差异有统计学意义（P〈O．05）。3种胆汁标志物的特异性与血清比较差异无统计学意义。胆管癌、胰腺癌、十二指肠乳头癌与胆管旁转移癌、肝癌比较CA19-9水平差异有统计学意义（P〈0．05）;无论是恶性狭窄组还是良性疾病组,细菌阳性胆汁与阴性胆汁组间CA19-9水平比较差异均有统计学意义（P〈0．05）。结论胆汁CA19-9、CEA、CA242水平对鉴别胆道良恶性疾病有一定帮助,但并不明显优于血清标志物。胆汁细菌感染可引起胆汁CA19-9水平升高,但不影响良恶性诊断结果。     

血清 CA19-9 水平在良性胆管疾病患者中的临床意义

背景: CA19-9是临床常用的肿瘤标记物,对胰胆系恶性肿瘤的阳性率较高,但良性胆管疾病中亦常见CA19-9水平升高。目的: 分析血清CA19-9水平在良性胆管疾病患者中的临床意义。方法: 选取2004年10月～2009年5月北京军区总医院的78例经ERCP证实的良性胆管疾病患者(60例胆总管结石和18例胆总管炎性狭窄)。所有患者于ERCP术前行血清CA19-9水平检测,并分析其在良性胆管疾病中的临床意义。结果: 39例(50.0%)患者血清CA19-9水平正常,其中胆总管结石26例(66.7%)。其余39例(50.0%)患者血清CA19-9水平升高,其中胆总管结石34例(87.2%);4例血清CA19-9水平1000U/ml者的年龄均65岁,并合并有严重化脓性梗阻性胆管炎或重症急性胰腺炎。16例血清CA19-9升高者于ERCP术后行复查,多数患者血清CA19-9水平明显下降。结论: 良性胆管疾病患者中血清CA19-9水平可升高,可作为预测胆管炎症程度的指标,尤其是在老年患者中。