阻塞性黄疸:PTC下胆道钳夹活检的技术方法学研究和临床应用

Obstructive jaundice: techno-methodological study and clinical application of percutaneous transhepatic cholangiobiopsy with forceps biopsy

目的探索一条获取胆道病变组织、进行胆道病理学检查的新途径。方法71例阻塞性黄疸接受经皮肝穿胆道造影(PTC)和经皮肝穿胆道引流(PTCD)治疗。PTCD过程中,影像监测下经皮经肝胆道穿刺,向胆道内引入活检钳行梗阻段钳夹活检和组织病理学检查。统计学分析用χ2检验,以α=005作为检验水准。结果71例钳夹活检病人中70例成功获得组织块,技术成功率986%(70/71)。钳夹活检病理学阳性率887%(63/71)。50例胆管癌钳夹活检敏感率高于15例非胆管癌(960%比600%,P<005)。结论PTC下胆道钳夹活检操作简单,获得组织块的技术成功率高,创伤小,敏感性高,是一种值得推广的胆道病理学诊断新途径。

Objective To explore a feasible bile ductal biopsy approach to acquire appropriate specimen for accurate pathological diagnosis of the obstructive jaundice (OJ). Methods Seventy-one consecutive patients with OJ underwent transluminal forceps biopsy during percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic cholangiographic drainage (PTCD). Multiple specimens were obtained after passing the forceps into the lesion for pathological diagnosis. Statistical analysis was performed with the χ2 test and a P value less than 0.05 was considered to be statistically different. Results The specimens was acquired in 70 out of the 71 patients with forceps biopsy and the successful rate was 98.6%. The histopathological diagnosis was obtained in 63 patients and the positive rate of forceps biopsy was 88.7% (63/71). The sensitivity of forceps biopsy was significantly higher in the 50 patients with cholangiocarcinoma than in those 15 with malignant tumors other than cholangiocarcinoma (96.0% vs 60.0%, P<0.05). Conclusions Biopsy during PTC is a simple technique of minimal invasion, no pain, high sensitivity and low occurring rate of complications.