对阻塞性黄疸行胆道活检的临床研究

目的探索一条胆道活检新途径，依据病理指导临床治疗阻塞性黄疸。方法在经皮肝穿刺胆管引流术(PTCD)过程中，82例阻塞性黄疸经经皮肝穿刺胆道造影术(PTC)途径向胆道内送入8F鞘管，引入活检钳和毛刷对梗阻段胆道钳夹活检和毛刷刷取获得标本，行组织学和细胞学检查。并进行x^2检验。结果82例胆道钳夹组织块的技术成功率为97．6％，活检中未发生严重并发症。82例钳夹活检中72例获得组织学诊断，钳夹病理学敏感率为87．8％。胆管癌钳夹活检敏感率较非胆管恶性肿瘤高(x^2=4．067，P=0．044)。74例毛刷刷取中56例获得细胞学诊断，诊断敏感率为75．7％；钳夹病理学敏感率较毛刷高，差异有显著性(x^2=3．886，P=0．049)，毛刷活检可作为钳夹活检的一种补充。结论PTC下胆道钳夹活检操作简单，技术成功率高，创伤小且并发症少，病理学诊断敏感性高，是值得推广的胆道病理学诊断新途径。

Clinical study of percutaneous transhepatic bile duct biopsy in obstructive jaundice

Objective To evaluate the technical feasibility and sensitivity of percutaneous bile duct biopsy in obstructive jaundice. Methods Eighty two consecutive patients with obstructive jaundice underwent transluminal bile duct biopsy and brushing since April 2001. The technique was performed through an existing percutaneous transhepatic tract. Multiple specimens were obtained after passing the forceps biopsy or brush into a long 8 French sheath and the specimens were fixed with formalin for pathologic or cytologic diagnosis. Results The successful rate of obtaining specimen with biopsy was 97.6%. There was no major complications occurred. The histopathologic diagnosis was established acquired in 72 of 82 patients with forceps biopsy(sensitivity 87.8%). Sensitivity of biopsy in the 56 patients with cholangiocarcinoma was higher than that in the 22 patients with malignant tumors other than cholangiocarcinoma (92.9% vs. 72.7% P =0.044). The cytologic diagnosis was established in 56 of 74 patients with brush cytology(sensitivity 75.7%). The sensitivity of biopsy in the 82 patients was higher than that of brushing in the 74 patients (87.8% vs. 75.7%, P = 0.049 ). Conclusion Percutaneous transhepatic bile duct biopsy is a simple, minimal invasion, high sensitivity and low complication procedure with high technical successive rate. It is a new approach to establish pathologic diagnosis