经皮经肝胆道内钳夹活检诊断胆道支架内再梗阻

Percutaneous Transhepatic Biliary Clamp Biopsy in the Diagnosis of Biliary Stent Reobstruction

目的评估经皮经肝胆道钳夹活检诊断胆道支架再梗阻的有效性。方法31例胆道支架植入术后发生支架内再梗阻[男19例,女12例,年龄47~83岁,平均(61.5±11.3)岁]接受透视引导下经皮经肝胆道钳夹活检术。评估技术成功率、并发症、手术时间及平均活检次数,分析敏感度、特异度、准确度、阳性预测率及阴性预测率。结果技术成功率100%,平均手术时间(23.0±6.3)min,平均活检次数(3.9±0.6)次,并发症发生率为9.7%(3/31),包括胆道出血2例,胆管炎1例,未出现大出血、胆道穿孔等严重并发症。23例被确诊为恶性肿瘤,3例诊断为真阴性,5例诊断为假阴性,无假阳性诊断。胆道钳夹活检对支架再梗阻的诊断性能:敏感度79.3%(23/29),特异度为100%(3/3),准确度为83.9%(26/31),阳性预测率为100%(23/23),阴性预测率为37.5%(3/8)。结论透视下经皮经肝胆道钳夹活检诊断胆道支架再梗阻技术安全可行。

Objective To evaluate the effectiveness of percutaneous transhepatic biliary clamp biopsy in the diagnosis of biliary stent re-obstruction.Methods From December 2015 to December 2019,31 patients with stent re-obstruction af-ter biliary stent implantation[19 males and 12 females,aged 47-83 years,mean age(61.5±11.3)years]underwent percutaneous transhepatic biliary clamp biopsy under fluoroscopy guidance.The technical success rate,complications,oper-ation time and average number of biopsies were evaluated,and the sensitivity,specificity,accuracy,positive predictive rate and negative predictive rate were analyzed.Results The technical success rate was 100%,the average operation time was(23.0±6.3)min,the average number of biopsies was 3.9±0.6,and the incidence of complications was 9.7%,including 2 cases of biliary bleeding and 1 case of cholangitis.There were no serious complications such as massive hemorrhage and bile duct perforation.Twenty-three cases were correctly diagnosed as malignant tumors,three were diagnosed as true-nega-tive,five were diagnosed as false-negative,and there were no false-positive diagnoses.The diagnostic performance of biliary clamp biopsy for stent re-obstruction:the sensitivity was 79.3%(23/29),the specificity was 100%(3/3),the accuracy was 83.9%(26/31),the positive predictive rate was 100%(23/23),and the negative predictive rate was 37.5%(3/8).Conclusion Percutaneous transhepatic biliary clamp biopsy under fluoroscopy is safe and feasible in the diagnosis of bili-ary stent re-obstruction.