经内镜逆行胰胆管造影术导丝辅助胆道活检技术在胆道恶性梗阻中的临床应用

Clinical application of guidewire-assisted biopsy through ERCP in treatment of biliary malignant obstruction

目的探讨经内镜逆行胰胆管造影术(ERCP)导丝辅助胆道活检技术在胆道恶性肿瘤合并胆道梗阻中的应用。方法在ERCP过程中,62例胆道恶性梗阻患者行ERCP时利用导丝辅助下向胆管内引入活检钳对病变处进行活检获取标本。结果经ERCP导丝辅助胆道活检技术行胆道活检夹取组织块成功率为100.0%,62例钳夹活检中41例获得组织学诊断,活检敏感性为66.1%,活检未发生严重并发症。同时研究发现胆管上中段活检阳性率(上段76.9%;中段78.6%)明显高于胆管下段(45.5%)(P<0.05),胆管原发肿瘤活检阳性率(88.2%)高于非胆管起源肿瘤(胰腺癌阳性率35.3%)引起的胆道梗阻(P<0.01)。结论经ERCP导丝辅助胆道活检技术是安全、简便、易于掌握地获取病理的一种有效手段,为梗阻性黄疸定性诊断提供了重要方法。

Objective To evaluate the guidewire-assisted biopsy technique through ERCP applied in biliary malignant obstruction. Methods During the ERCP procedure, biopsy forceps assisted by guidewire inserted into the bile duct to biopsy the lesion and obtain specimens in 62 cases of malignant biliary obstruction. Results Success rate was100.0%, 46 cases were histological diagnosed by forceps biopsy in 62 cases, Positive diagnosis rate was 66.1%.There was no serious complications occurred after biopsy. The study also found that positive biopsy rate in the upper and middle bile duct（upper 76.9%; middle 78.6%） was significantly higher than the distal bile duct（35.3%）（P〈0.05）, primary cholangiocarcinoma biopsy positive rate（88.2%） was higher than cancer of non-biliary origin（pancreatic cancer 47.1%）（P〈0.01）.Conclusion Guidewire-assisted biopsy through ERCP is safe, simple,easy technique and effective to obtaining pathological specimens, it also provides an important method in diagnosis of obstructive jaundice.