活组织和细胞学检查对恶性胆总管狭窄的诊断价值

目的探讨恶性胆总管狭窄的诊断技术.方法前瞻性地评估镜下毛刷细胞学检查和活组织检查恶性胆总管狭窄的诊断结果,在94个连续检查病人中52例在荧光镜指导下行胆管内活组织检查和毛刷细胞学检查,42例只行毛刷细胞学检查,其中64例为恶性狭窄,30例为良性狭窄.为了统计方便,我们将这些结果分类为恶性肿瘤阳性和阴性.结果两种技术的敏感性相同(52.8%),联合用两种技术所取得的收益较小(61.1%),其特性证明两种方法都是完好的,一种严重的并发症是肝总管穿孔溢胆汁,它可通过外科缝合术得以解决,这种并发症由活组织检查和病人自己过早地拔除鼻胆引流管所致.结论在一般情况下,对胆总管狭窄的诊断只行毛刷细胞学检查就足够,如果先行毛刷细胞学检查结果阴性,病人整个胆管梗阻或者狭窄位于壶腹内管可使用活组织检查,活组织检查并非易事,为防止并发症的发生,这项技术有待进一步提高.

The diagnostic value of endoscopic retrograde forceps biopsy and brush cytology for malignant common bile duct strictures

Objective To study the diagnostic techniques of malignant bile duct strictures.Methods We prospectively evaluated the results of endoscopic brash cytology and biopsy for the diagnosis of ma- lignant common bile duct strictures.Fluoroscopically guided endobiliary biopsy and brash-cytology were perforated on 52 patients and cytology alone on 42 patients in 94 consecutive patients among whon 64 had malignant strictures and 30 benign strictures.We classified the results of these studies as positive or negative for malignancy so as to use statistics easily.Results The sensitivitles of the two teclmiques were identical(52.8%)and the gains achieved by combining the two teclmiques was small(61.1%).Their specificity proved perfect for both methods.One serious complication that occurred was perforation of the common hepatic duct with leakage of bile,which was managed by surgical oversewing.This complication was caused by biopsy and untimely removal of the nasobiliary drain by the patient herself or himself.Conclusions It is sufficient for the diagnosis of malignant bile duct strictures to adopt endoscopic retrograde brush cy- tology alone in general situation.Forceps biopsy can be used in cases of complete ductal obstructions, or in strictures located in the intra-ampullary tract,if theresuh of preyious brush cytology was negative. It is not easy to forceps biopsy,and this technique needs to be improved in order to prevent the occurrence of the complications.