SpyGlass内镜直视系统在胆胰管狭窄及胆管巨大结石中的诊治作用

目的 评估SpyGlass内镜直视系统对胆管、胰管狭窄的性质判断及胆管巨大结石的诊治效果。方法 收集2012年9月—2018年8月期间因不明原因胆管、胰管狭窄或胆管巨大结石在杭州市第一人民医院行SpyGlass诊治的患者资料。采用SpyGlass视觉诊断不明原因胆胰管狭窄，部分患者行Spybite活检；胆管巨大结石采用SpyGlass直视联合激光碎石治疗。分析SpyGlass诊治的操作成功率、临床成功率和并发症发生率。结果 共114例胆管狭窄、11例胰管狭窄和19例胆管巨大结石患者接受了SpyGlass诊治，总操作成功率为98.6%（142/144）。SpyGlass视觉诊断不明原因胆管狭窄性质的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为97.1％（67/69）、95.3％（41/43）、96.4%（108/112）、97.1％（67/69）和95.3％（41/43）。SpyGlass视觉诊断不明原因胰管狭窄性质的准确率为100.0%(11/11)。19例巨大胆管结石患者的碎石率为89.5%（17/19），首次取石成功率为73.7%(14/19)，5例首次取石失败的患者二次取石均成功，总取石成功率为100.0%（19/19）。共4例（2.8%）患者出现术后并发症，其中急性胆管炎3例、轻症急性胰腺炎1例。结论 SpyGlass诊断不明原因胆管、胰管狭窄准确、安全；SpyGlass联合激光碎石治疗胆管巨大结石安全、有效。

The diagnostic and therapeutic value of SpyGlass direct visualization system for cholangiopancreatic duct stenosis and large bile duct stones

Objective To evaluate the diagnostic and therapeutic effect of SpyGlass direct visualization system (SpyGlass) on cholangiopancreatic duct stenosis and large bile duct stones. Methods Patients with cholangiopancreatic duct stenosis or large bile duct stones of indeterminate reasons who underwent SpyGlass at Hangzhou First People''s Hospital from September 2012 to August 2018 were recruited. Cholangiopancreatic duct stenosis were visually diagnosed using SpyGlass, and some patients underwent Spybite biopsy. Large bile duct stones were treated with SpyGlass-guided laser lithotripsy under direct visualization. The procedure success rate, clinical success rate, and adverse event incidence associated with SpyGlass were analyzed. Results SpyGlass was performed to diagnose and treat 114 patients with bile duct stricture, 11 patients with pancreatic duct stricture and 19 patients with large bile duct stones. The total procedure success rate was 98.6% (142/144). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SpyGlass visual diagnosis of bile duct stricture of indeterminate reasons were 97.1% (67/69), 95.3% (41/43), 96.4% (108/112), 97.1% (67/69), and 95.3% (41/43), respectively. The accuracy of SpyGlass visual diagnosis of pancreatic duct stricture of indeterminate reasons was 100.0% (11/11). Of the 19 patients with large bile duct stones, the lithotripsy success rate was 89.5% (17/19). The success rate of primary extraction was 73.7% (14/19), and that of secondary extraction was 100.0% (5/5). The total extraction success rate was 100.0% (19/19) Four patients (2.8%) had postoperative complications, including three cases of acute cholangitis and one case of mild acute pancreatitis. Conclusion SpyGlass is accurate and safe in the diagnosis of cholangiopancreatic duct stenosis. It is also effective and safe for treating large bile duct stones combined with laser lithotripsy.