内镜下逆行胰胆管造影胆道刷检对良恶性胆道狭窄的诊断价值*

Diagnostic value of ERCP biliary brushing for benign and malignant biliary stricture*

摘要:

探讨内镜下逆行胰胆管造影（ERCP）术中行胆道刷检对良恶性胆道狭窄的诊断价值。方法?选取2015年9月－2018年10月因梗阻性黄疸入住贵州医科大学附属医院行ERCP诊治的患者的临床资料，随机收集术中造影显示胆道狭窄的患者45例，常规行胆道细胞刷片并进行细胞病理学分析。结果?细胞病理学报告细胞核增大、核膜不规则、核仁明显、具有多个核仁的染色质凝集、核浆比增大、细胞异型性明显、常见小团的散落的异型性细胞簇时，胆道刷检细胞学对恶性胆道狭窄诊断的意义更大。32例（71.11%）患者最终诊断为恶性胆道狭窄，其中22例通过组织病理学检查确诊，10例通过疾病进展和影像学检查明确诊断。Logistic回归分析显示，胆道狭窄长度（OR=8.375，95%CI：1.249～56.173）是恶性胆道狭窄的危险因素。结论?ERCP胆道细胞刷检是一项安全可靠的检查方法，充分的取材、良好的制片方法和严格的细胞形态学诊断标准，均对良恶性胆道狭窄的鉴别有较好的价值。

Abstract:

To investigate the diagnostic value of biliary brushing for endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of benign and malignant biliary stricture. Methods From September 2015 to October 2018, patients underwent ERCP due to obstructive jaundice were randomly enrolled in the study. 45 patients with biliary stenosis underwent ERCP were enrolled and underwent routine biliary tract brushing and cytopathology analysis. All of their clinical data were collected. Results Cytopathology report showed an increase in cell nuclei, irregular nuclear membrane, obvious nucleoli, chromatin agglutination with multiple nucleoli, increased nucleoplasmic ratio, obvious cell atypia, and the biliary brushing cytology with common small clusters of heterogeneous cell clusters is more important in the diagnosis of malignant biliary stricture. Thirty-two (71.11%) patients were diagnosed with malignant biliary stricture by final diagnosis, of which 22 were diagnosed by histopathology and 10 were diagnosed by disease progression and imaging. According to logistic regression analysis, the length of biliary stenosis (OR = 8.375, 95.00% CI: 1.249 ~ 56.173) is a risk factor for malignant biliary stricture. Conclusion ERCP biliary cell brushing is a safe and reliable method, which has good value for the identification of benign and malignant biliary strictures due to adequate material extraction, good preparation methods and strict cell morphology diagnostic criteria.