SpyGlass单人操作胆道镜系统对胆道疾病的诊治价值

Value of SpyGlass single-operator choledochoscopy system in the diagnosis and treatment of patients with biliary tract diseases

目的评估SpyGlass单人操作胆道镜系统对不明原因的胆管狭窄、复杂胆管结石及其他胆道疾病的诊疗价值。方法回顾性收集2017年12月—2020年6月在南京医科大学第二附属医院行SpyGlass下诊治胆道疾病患者的临床资料。胆管狭窄患者在SpyGlass引导下对病灶部位进行充分可视化,必要时取活检;胆管结石患者行SpyGlas胆道镜直视下激光碎石;胆囊病变患者通过SpyGlass辅助下超选胆囊管。分析SpyGlass系统诊治的敏感度、特异度、准确度、碎石成功率、结石清除率、操作成功率以及并发症发生率。结果共有58例患者进行SpyGlass操作。44例(76%)用于评估性质不明的胆道狭窄,SpyGlass视觉印象的诊断敏感度为92%(24/26),特异度为94%(17/18),准确度为93%(41/44),SpyBite直视活检的诊断敏感度为71%(15/21),特异度为92%(11/12),准确度为79%(26/33);8例(14%)用于胆管结石的治疗,碎石成功率为83%(5/6),结石清除率为88%(7/8);5例(9%)用于SpyGlass下引导导丝超选胆囊管,操作成功率为80%(4/5);1例(1%)用于肝移植术后合并胆总管结石的辅助取石及胆管吻合口狭窄的治疗。术后共有5例(9%)患者出现并发症。结论SpyGlass胆道镜系统能准确、安全、有效地应用于不明原因的胆管狭窄、复杂胆管结石以及其他胆道疾病的诊治。

Objective To investigate the value of SpyGlass single-operator choledochoscopy system in the diagnosis and treatment of patients with unexplained biliary stricture,complex bile duct stones,or other biliary tract diseases.Methods A retrospective analysis was performed for the clinical data of the patients with biliary tract diseases who were diagnosed and treated with SpyGlass in The Second Affiliated Hospital of Nanjing Medical University from December 2017 to June 2020.For the patients with biliary stricture,the biliary lesions were fully visualized under the guidance of SpyGlass,and SpyBite biopsy was performed if necessary;the patients with bile duct stones were treated with SpyGlass-guided direct-view laser lithotripsy;for the patients with gallbladder disease,the cystic duct was superselected with the assistance of SpyGlass.The SpyGlass system was analyzed in terms of its sensitivity,specificity,and accuracy rate in diagnosis and treatment,lithotripsy success rate,stone clearance rate,procedure success rate,and incidence rate of complications.Results A total of 58 patients underwent SpyGlass procedure.SpyGlass was used to evaluate biliary stricture of unknown nature in 44(76%)patients;SpyGlass visual impression had a diagnostic sensitivity of 92%(24/26),a specificity of 94%(17/18),and an accuracy of 93%(41/44),and SpyBite biopsy had a diagnostic sensitivity of 71%(15/21),a specificity of 92%(11/12),and an accuracy of 79%(26/33).SpyGlass was used for the treatment of bile duct stones in 8 patients(14%),with a lithotripsy success rate of 83%(5/6)and a stone clearance rate of 88%(7/8).A guide wire under the SpyGlass system was to superselect the cystic duct in 5 patients(9%),with a procedure success rate of 80%(4/5).In one patient(1%),SpyGlass was used to assist the removal of common bile duct stones after liver transplantation and the treatment of bile duct anastomotic stricture.A total of 5 patients(9%)experienced complications after surgery.Conclusion The SpyGlass choledochoscopy system is accurate,safe,and effective in the diagnosis and treatment of unexplained biliary stricture,complex bile duct stones,and other biliary tract diseases.