胆汁细胞学检查和血清肿瘤标志物检测对胆道恶性狭窄的诊断价值

The diagnostic values of bile cytology and blood tumor markers for malignant bile duct obstruction

目的探讨胆汁细胞学检查和血清肿瘤标志物检测对胆道恶性狭窄的诊断价值。方法2005年8月至2009年4月对47例胆管狭窄病例经ERCP抽取胆汁行细胞学检查并行血清肿瘤标志物检测，其中胆管恶性狭窄39例，胆管良性狭窄8例。结果39例胆道恶性狭窄病例中胆汁细胞学检查阳性26例，敏感性66．7％，血清CA19-9检测阳性28例，敏感性71．8％；8例良性狭窄病例中胆汁细胞学检查阴性8例，特异性100．0％，血清CA19—9阴性7例，特异性87．5％。26例胆管癌病例中血清CA19-9检测阳性18例，敏感性69．2％。胆汁细胞学检查和血清CA19-9联合检测，平行法联合检测敏感性89．7％，系列法联合检测特异性100．0％。结论胆汁细胞学检查能够为胆道恶性狭窄疾病的诊断提供病理学依据，具有临床应用价值。联合检测胆汁细胞学和血清CA19．9，提高了诊断敏感性，具有重要的临床应用价值。

Objective To explore the diagnostic values of bile cytology obtained in endoscopic retrograde cholangiopancreatography （ERCP） and blood tumor markers for malignant bile duct obstruction. Methods From August 2005 to April 2009, bile cytology and blood tumor markers measurement were performed in 47 cases with bile duct obstruction, in which 39 cases were confirmed to be malignant and 8 were benign. Results Malignant cells were found in bile from 26 of 39 malignant obstruction （66. 7% ）, and serum CA19-9 was positive in 28 （71.8%）. No malignant cells were detected in bile cytology from 8 cases with benign obstruction （with a specificity of 100% ） and serum CA19-9 was negative in 7 （87.5%）. In 26 patients with cholangiocarcinoma, serum CA19-9 was positive in 18 （69. 2% ）. For bile cytology and blood tumor markers test, sensitivity of parallel combination was 89. 7%, and the specificity of serial combination was 100. 0%. Conclusion Bile cytology testing during ERCP can provide the pathological evidence for malignant bile duct obstruction. The sensitivity is improved by combination tests of bile cytology and blood tumor markers.