ERCP中细胞刷检和胆汁肿瘤标志物测定在胆管癌诊断中的价值

The Diagnostic Values of Cytological Brushings and Bile Tumor Markers Assays During ERCP in Cholangiocarcinoma

目的探讨ERCP及细胞刷检和胆汁肿瘤标志物测定在胆管癌诊断中的价值。方法收集胆道疾病患者41例,按照诊断标准分成2组,回顾分析两组的ERCP、细胞刷检和胆汁肿瘤标志物检测。结果ERCP、US、CT、MRCP对胆管癌的定位诊断率分别为96.0%、60.0%、63.2%、70.8%（P〈0.05）,前者分别与后三者比较（P〈0.01～0.05）。胆管细胞刷检与胆汁细胞学检查,其灵敏度分别为53.8、7.7%,两者比较（P〈0.05）;胆管癌组胆汁CA19-9水平高于良性胆管病变组（P〈0.01）;US、ERCP、细胞刷检和胆汁CA19-9联合检测,平行法联合检测灵敏度92.3%,系列法联合检测特异度100.0%。结论ERCP对胆管癌诊断的敏感性优于US、CT、MRCP;ERCP中进行细胞刷检对胆管癌有较大的诊断价值;检测胆汁中CA19-9水平对诊断胆管癌具有较大的临床价值;US、ER-CP、细胞刷检和胆汁CA19-9联合检测在胆管癌诊断中有重要价值。

Objectives To explore the diagnostic value of cytological brushings and bile tumor markers determination during ERCP for cholangiocarcinoma. Methods Forty-one patients were divided into two groups. In either of the two groups, the diagnostic results of various imaging methods,cytological brushings, and bile tumor markers were analyzed retrospectively. Results The diagnostic accuracy rates of tumor location of ERCP,US,CT and MRCP for cholangiocarcinoma were 96.0%, 60.0%, 63.2%, 70.8%, respectively. When the first compared with the latter three respectively, the differences were significant. The overall sensitivity of brush cytology 53.8% was significantly greater than bile cytology 7.7%. The bile CA19-9 level was obviously higher in the malignant group than that in the benign one. The sensitivity of parallel combined testing of US, ERCP,cytological brushings and bile CA19-9 in diagnosing cholangiocarcinoma was 92.3 %, and the specificity of serial combined examination of US, ERCP, cytological brushings and bile CA19-9 was 100.0%. Conclusion ERCP is superior to US,CT and MRCP;Brush cytology is more sensitive than bile cytology; Elevation of bile CA19-9 level is valuable in diagnosis of cholan- giocarcinoma;Combined testing of US, ERCP, cytological brushings and bile CA19-9 has an important value in the diagnosis of cholangiocarcinoma.