经内镜逆行胰胆管造影术导丝辅助胆道活检与超声内镜引导下穿刺活检诊断恶性胆管狭窄的对比研究

Comparison of guidewire-assisted biopsy through ERCP and EUS-FNA in the diagnosis of malignant biliary stricture

目的比较经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)导丝辅助胆道活检与超声内镜引导下穿刺活检(endoscopic ultrasonography guided fine needle aspiration,EUS-FNA)诊断恶性胆管狭窄的差异性。方法回顾性分析2016年8月至2018年8月于武汉大学人民医院就诊的恶性胆管梗阻患者128例,其中经ERCP导丝辅助胆道活检患者63例,EUS-FNA检查患者65例。比较两组检查方法灵敏性的差异。结果经ERCP导丝辅助胆道活检患者中36例获得组织学诊断,活检灵敏性为57.1%;行EUS-FNA检查65例患者中47例获得组织学诊断,灵敏性为72.3%;所有病例均未发生严重并发症。其中肝门部胆管梗阻及胆总管中上段63例,ERCP导丝辅助胆道活检患者35例,其中23例获得组织学诊断,灵敏性为65.7%;EUS-FNA检查患者28例,18例获得组织学诊断,灵敏性为64.3%;胆总管远端胆管梗阻患者65例,ERCP导丝辅助胆道活检患者28例,13例获得组织学诊断,灵敏性为46.4%;EUS-FNA检查患者37例,29例获得组织学诊断,灵敏性为78.4%。结论经ERCP导丝辅助胆道活检及EUS-FNA技术均是胆道恶性梗阻的安全、简便、易于掌握的获取组织的有效手段,EUS-FNA更适用于胆总管远端梗阻的诊断。

Objective To compare the methods of guidewire-assisted biopsy through endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasonography guided fine needle aspiration(EUS-FNA) in the diagnosis of malignant biliary stricture.Methods A retrospective analysis was made of 128 patients with malignant biliary obstruction admitted to Renmin Hospital of Wuhan University from Aug. 2016 to Aug. 2018, including 63 patients with guidewire-assisted biopsy through ERCP and 65 patients with EUS-FNA. The sensitivity of the two groups was compared.Results For all patients received guidewire-assisted biopsy through ERCP, 36 cases were pathological diagnosed by forceps biopsy. The sensitivity was 57.1%. For all patients received EUS-FNA, 47 cases were pathological diagnosed. The sensitivity was 72.3%. No serious complications occurred in all cases. Lesions located in the upper and middle bile duct in 63 cases. 35 patients received guidewire-assisted biopsy through ERCP, 23 cases were pathological diagnosed by forceps biopsy. The sensitivity was 65.7%. 28 patients received EUS-FNA, 18 cases were pathological diagnosed by forceps biopsy. The sensitivity was 64.3%. Lesions located in the distal bile duct in 65 cases. 28 patients received guidewire-assisted biopsy through ERCP, 13 cases were pathological diagnosed by forceps biopsy. The sensitivity was 46.4%. 37 patients received EUS-FNA, 29 cases were pathological diagnosed by forceps biopsy. The sensitivity was 78.4%.Conclusion Guidewire-assisted biopsy through ERCP and EUS-FNA are all safe, simple and easy-to-master methods for obtaining pathology for malignant biliary obstruction. EUS-FNA is more suitable for the diagnosis of distal common bile duct obstruction.