经皮经肝穿刺胆道造影术下胆道活检诊断恶性阻塞性黄疸

Percutaneous transhepatic transluminal cholangiobiopsy in diagnosis of malignant obstructive jaundice

目的 :探索经皮经肝穿刺胆道造影 (PTC)下胆道活检的可行性和敏感性 ,明确病变的组织病理学特性 ,指导临床治疗。方法 :2 4例恶性阻塞性黄疸患者 ,在行PTCD(经皮经肝穿刺胆道内外引流术 )减黄术中 ,进行PTC术胆道活检。通过经皮经肝胆道穿刺通道向胆道内送入 8F鞘 ,活检钳经鞘内送入并对病变狭窄段行胆道钳夹活检 ,获取多个标本 ,行组织病理学检查。结果 :2 4例患者 2 2例获得组织病理学诊断 ,阳性率为 91.6 7%。病理报告胆管腺癌 15例 ,胆管鳞癌 1例 ,胰腺癌 2例 ,肝癌 2例 ,胃腺癌胆总管转移 1例 ,硬化性胆管炎 1例 ,阴性结果 2例。结论 :PTC下胆道活检是一种简单易行。

Aim: To explore the technical feasibility and sensitivity of percutaneous transhepatic cholangiobiopsy in malignant obstructive jaundice, and guide the clinic to treat disease. Methods:A total of 24 patients with malignant obstructive jaundice who were treated by percutaneous transhepatic cholangiograph and drainage accepted percutaneous transhepatic cholangiobiopsy.The technique was performed through an existing percutaneous transhepatic tract.Multiple specimens were obtained after passing the forceps biopsy into a long 8 French sheath and the specimens were fixed with formalin, and then for histopathologic diagnosis. Results: The histopathologic diagnosis was acquired in 22 of 24 patients, the positive rate was 91.67%(22/24).Pathologic reports included cholangioadenocarcinoma ( n =15),cholangiosquamocarcinoma ( n =1), pancreatic adenocarcinoma ( n =2), hepatoma with common bile duct invasion ( n =2), stomachoadenocarcinoma with common bile duct metastasis ( n =1) and sclerotic cholangitis ( n =1).Conclusion: Percutaneous transhepatic cholangiobiopsy is an accurate and reliable way which is safe and easy to perform to acquire histopathologic diagnosis.