经口胆道镜引导靶向活检与十二指肠镜下经乳头活检钳活检对胆管狭窄伴可疑胆管癌诊断效能比较

Comparison of diagnostic efficiency of peroral choledochoscopy-guided targeted biopsy and duodenoscope transpapillary biopsy forceps for biliary stricture with suspected cholangiocarcinoma

目的比较经口胆道镜引导靶向活检与十二指肠镜下经乳头活检钳活检对胆管狭窄伴可疑胆管癌的诊断效能。方法选择2018年4月至2021年4月南阳市中心医院收治的82例胆管狭窄疑似胆管癌患者为研究对象,患者均接受经口胆道镜引导靶向活检及十二指肠镜下经乳头活检钳活检。以术后病灶组织病理学检查结果及至少随访1 a以上诊断结果为最终诊断结果,比较2种活检方法对胆管癌的诊断效能,并评估2种活检方式的安全性。结果最终诊断结果显示,82例胆管狭窄疑似胆管癌患者中60例确诊为胆管癌;22例确诊为良性胆管狭窄,其中高位胆管狭窄10例,低位胆管狭窄12例。经口胆道镜引导靶向活检诊断为胆管癌53例,最终诊断为胆管癌50例;诊断为胆管狭窄29例,最终诊断为胆管癌10例。十二指肠镜下经乳头活检钳活检诊断为胆管癌42例,最终诊断为胆管癌32例;诊断为胆管狭窄40例,最终诊断为胆管癌28例。经口胆道镜引导靶向活检诊断胆管癌的灵敏度为83.33%,特异度为86.36%,准确度为84.15%,阳性预测值为94.34%,阴性预测值为65.52%;十二指肠镜下经乳头活检钳活检诊断胆管癌的灵敏度为53.33%,特异度为54.55%,准确度为53.66%,阳性预测值为76.19%,阴性预测值为30.00%;十二指肠镜下经乳头活检钳活检诊断胆管癌的灵敏度、特异度、准确度、阳性预测值及阴性预测值显著低于经口胆道镜引导靶向活检(χ^(2)=12.478、5.350、17.786、6.534、8.571,P<0.05)。2种活检方法均可导致患者血C-反应蛋白水平增高,但未导致患者发生胆管穿孔、肠穿孔等并发症及操作相关性死亡。结论与十二指肠镜下经乳头活检钳活检相比,经口胆道镜引导靶向活检对于胆管狭窄疑似胆管癌患者诊断效能更高,且较为安全。

Objective To compare the diagnostic value of peroral choledochoscopy-guided targeted biopsy and duodenoscope transpapillary biopsy forceps for biliary stricture with suspected cholangiocarcinoma.Methods A total of 82 patients with biliary stricture with suspected cholangiocarcinoma admitted to Nanyang Central Hospital from April 2018 to April 2021 were selected as the research subjects.All patients underwent peroral choledochoscopy-guided targeted biopsy and duodenoscope transpapillary biopsy forceps.The final diagnosis was accorded to the histopathological examination results of the focus after surgery and the diagnosis results at least one year follow-up;the diagnostic efficiency of the two biopsy methods for cholangiocarcinoma was compared,and the safety of the two biopsy methods was evaluated.Results The final diagnosis showed that among the 82 patients with biliary stricture with suspected cholangiocarcinoma,60 cases were cholangiocarcinoma,22 cases were benign biliary stricture,and 10 cases were high biliary stricture,12 cases were low biliary stricture.There were 53 cases of cholangiocarcinoma diagnosed by peroral choledochoscopy-guided targeted biopsy,and 50 cases were finally diagnosed as cholangiocarcinoma;there were 29 cases of biliary stricture diagnosed by peroral choledochoscopy-guided targeted biopsy,and 10 cases were finally diagnosed as cholangiocarcinoma.There were 42 cases of cholangiocarcinoma diagnosed by duodenoscope transpapillary biopsy forceps,and 32 cases were finally diagnosed as cholangiocarcinoma;there were 40 cases of biliary stricture diagnosed by duodenoscope transpapillary biopsy forceps,and 28 cases were finally diagnosed as cholangiocarcinoma.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of peroral choledochoscopy-guided targeted biopsy in the diagnosis of cholangiocarcinoma were 83.33%,86.36%,84.15%,94.34%and 65.52%,respectively;the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of duodenoscope transpapillary biopsy forceps in the diagnosis of cholangiocarcinoma were 53.33%,54.55%,53.66%,76.19%and 30.00%,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of duodenoscope transpapillary biopsy forceps in the diagnosis of cholangiocarcinoma were significantly lower than those of peroral choledochoscopy-guided targeted biopsy(χ^(2)=12.478,5.350,17.786,6.534,8.571;P<0.05).Both the biopsy methods resulted in an increase of blood C-reactive protein levels in patients,but they did not result in complications such as bile duct perforation and intestinal perforation,as well as operator-related deaths.Conclusion Compared with duodenoscope transpapillary biopsy forceps,peroral choledochoscopy-guided targeted biopsy is more valuable in the diagnosis of biliary stricture with suspected cholangiocarcinoma,and the two biopsy methods are safe.