经ERCP导丝引导胆道活检结合气囊扩张涂片在诊断肝门部胆管恶性肿瘤中的应用

Application of the guidewire-assisted biopsy and balloon dilatation cytology smear through ERCP in diagnosis of patients with hilar cholangiocarcinoma

摘要:

探讨经内镜逆行胰胆管造影术（ERCP）导丝辅助胆道活检结合柱状气囊扩张后涂片在诊断肝门部胆道恶性肿瘤中的应用。方法 在ERCP过程中，52例肝门部胆道恶性肿瘤患者行ERCP时给予柱状气囊扩张狭窄处，同时将气囊表面残留物涂片进行细胞学检查；并配合导丝辅助下向胆管内引入活检钳对病变处进行活检获取标本。结果 经ERCP导丝辅助胆道活检技术行肝门部病变胆道活检夹取组织块成功率为100.0%，52例钳夹活检中31例获得组织学诊断，活检阳性率为59.6%；行柱状气囊扩张后细胞涂片中有22例获得细胞学诊断，阳性率为42.3%；涂片联合活检，共有34例获得确诊，阳性率65.4%，所有病例未发生严重并发症。结论 经ERCP导丝辅助进行肝门部胆道活检技术是安全、简便、易于掌握的获取病理的一种有效手段，联合柱状气囊扩张后的气囊表面残留物涂片病理检查可作为钳夹活检的一种补充，为肝门部肿瘤病理诊断提供了一种有效手段。

Abstract:

Abstract: Objective To evaluate the application of guidewire-assisted biopsy and balloon dilatation cytology smear through ERCP in diagnosis of patients with hilar cholangiocarcinoma. Methods During the ERCP procedure, 52 patients with hilar cholangiocarcinoma were treated with balloon dilatation, and cytology smear from the surface of the balloon. At the same time, biopsy forceps assisted by guidewire inserted into the bile duct to biopsy the lesion and obtain specimens. Results Success rate of obtaining histopathological through ERCP guidewire assisted biopsy in biliary bile duct was 100.0%, 31 cases were histological diagnosed by forceps biopsy in 52 cases, positive diagnosis rate was 59.6%; The patient with balloon dilatation in 52 cases give cytology smears obtained diagnosis in 22 cases, the positive rate was 42.3%; cytology smear combined with biopsy, a total of 34 cases were diagnosed, the positive rate was 65.4%. There was no serious complications occurred. Conclusion Biopsy assisted by guidewire through ERCP is a safe, simple, easy technique and an effective means of obtaining pathological, meanwhile, the cytology smear after balloon dilatation can be used as a supplement to biopsy, and provides an effective means in pathological diagnosis of hilar cholangiocarcinoma.