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经内镜细胞刷检查对胆管恶性狭窄性病变的诊断价值

(2014-10-22 12:38:17)

          目的 探讨经内镜细胞刷检查对胆管恶性狭窄性病变的诊断价值,分析影响诊断的因素。

          方法 对ERCP检查发现可疑胆管恶性狭窄的144例患者行胆管细胞刷检查。2004年-2006年在胆管内来回拉刷10次;2007年-2009年在狭窄部位来回拉刷20次,并重复操作2次。专业病理医师固定阅片,对照术后病理诊断和(或)临床最终诊断,分析细胞刷检查诊断胆管狭窄病变的作用。

          结果 最终诊断96例为胆管恶性狭窄,48例良性狭窄。恶性狭窄患者中78例细胞刷检查阳性(敏感度 81.3%),18例阴性;良性狭窄患者细胞刷检查均为阴性(特异度 100.0%);总体准确率87.5%。2007年-2009年间恶性狭窄性病变细胞刷检出率为87.7% (50/57),2004年-2006年间检出率仅为71.8%(28/39),差异有统计学意义(P<0.05=。细胞刷检查阳性率与肿瘤来源及狭窄部位无明显关系。术后发生4例轻度胰腺炎、3例胆管炎、2例胆管出血,无严重并发症发生。

          结论 胆管细胞刷检查对恶性胆管狭窄病变具有较高的特异度和敏感度,于狭窄部位反复拉刷和重复操作有助于提高细胞刷检阳性率。

         关键词:胆管肿瘤; 细胞刷检查; 胰胆管造影术,内窥镜逆行

    E-mail: wang78xia@hotmail.com

    Endoscopic brush cytology for diagnosis of malignant biliary stricture.

    Objective  To evaluate brush cytology under endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary strictures, and to analyze the factors influencing the diagnosis yield.

    Method  Brush cytology was applied in 144 patients with suspected malignant biliary strictures at ERCP. Brushing in bile duct was performed for 10 times from 2004 to 2006, while at least 20 times of brushing and repeated manipulation were performed at biliary strictures from 2007 to 2009. Cytological samples were processed immediately after brushing and analyzed by the same pathologist. Efficacy of brush diagnosis was evaluated based on reference to histopathology after surgery and/ or clinical diagnostic criteria.

    Results  Malignant stricture was finally diagnosed in 96 patients, and benign diseases in other 48. Brush cytology was positive in 78 of 96 patients with malignant stricture (sensitivity 81.3%), and negative in all patients without malignancy (specificity 100.0%). Overall accuracy of diagnosis was 87.5%. Positive rate of malignancy by brush between 2007 and 2009 was 87.7%(50/57), while that between 2004 and 2006 was 71.8%, which were significantly different (P<0.05). The positive rate was not correlated with stricture location or tumor type. No major complications occurred, except for 4 moderate acute pancreatitis, 3 cholangiolitis and 2 biliary bleeding.

    Conclusion  Brush cytology is of high sensitivity and specificity for malignant biliary stricture. Repeated brushing and manipulation can facilitate diagnosis yield.

    Key words: Biliary duct neoplasns; Brushing cytology; Cholangiopancreatography, endoscopic; retrograde

    ZHANG Xiao-feng (Department of Gastroenterology, The First People’s Hospital of Hangzhou, Hangzhou 310006, China), WANG Xia, ZHANG Xiao, et al//Chin J Dig Endosc,2011,28(1).9-12.

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个人资料
    张筱凤 单位:杭州市第一人民医院
    所属科室:
    出生:1976-03-17
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