新型SpyGlass经口胆道镜对性质不明胆管狭窄的诊断价值

The diagnostic value of the novel SpyGlass peroral choledochoscopy for indeterminate biliary strictures

目的探讨数字式经口胆道镜在诊断性质不明胆管狭窄中的价值。方法回顾性分析2018年1月—2019年1月期间,在海军军医大学附属东方肝胆外科医院采用第二代SpyGlass评估的66例胆管狭窄患者的临床资料,观察胆管狭窄的影像特点及类型,以病理和长期随访结果为金标准,评估SpyGlass视觉印象的敏感度、特异度、阳性预测值和阴性预测值。结果根据病理、其他影像以及长期随访的结果,20例患者被确诊为胆管良性狭窄,46例为恶性肿瘤。SpyGlass视觉印象的诊断敏感度为100.0%(46/46),特异度为90.0%(18/20),阳性预测值为95.8%(46/48),阴性预测值为100.0%(18/18)。SpyGlass下病变部位发现不规则血管或质地松脆易出血是恶性狭窄最为常见的表现。结论新一代SpyGlass系统能够对多数良、恶性胆管狭窄进行影像特征评估,具有较高的敏感度。

Objective To investigate the value of the novel SpyGlass peroral choledochoscopy for the diagnosis of indeterminate biliary strictures.Methods Data of 66 patients with biliary strictures assessed by the second generation SpyGlass were collected in the retrospective study from January 2018 to January 2019.The imaging characteristics and type of biliary strictures were observed.The sensitivity,specificity,positive predictive value and negative predictive value of SpyGlass were evaluated with the results of pathology and long-term follow-up results as the golden standard.Results A total of 20 benign biliary stricture and 46 malignant biliary stricture were confirmed by pathology,other imaging examinations and long-term follow-up results.The sensitivity,specificity,positive predictive value and negative predictive value of SpyGlass were 100.0%(46/46),90.0%(18/20),95.8%(46/48)and 100.0%(18/18),respectively.Vessels of irregular morphology or brittle texture was the most common manifestation of malignant strictures under SpyGlass observation.Conclusion The novel SpyGlass system can evaluate imaging features of most benign and malignant biliary strictures with high sensitivity.