内镜逆行胰胆管造影术下胰胆管联合刷检在壶腹部恶性肿瘤中的临床应用

Clinical application of combined pancreaticobiliary brushing under endoscopic retrograde cholangiopancreatography in ampulla malignant tumours

摘要:

目的 探讨内镜逆行胰胆管造影术（ERCP）下胰胆管联合刷检治疗壶腹部恶性肿瘤的临床应用价值。方法 回顾性分析2013年1月－2023年12月该院收治的行ERCP治疗的59例壶腹部恶性肿瘤患者的临床资料，分别行胰胆管联合刷检（胰胆管联合刷检组，n = 10）和单独胆管刷检（胆管刷检组，n = 49）。比较两组患者壶腹部恶性肿瘤的病理阳性检出率、胆红素下降幅度和术后并发症发生情况。结果 胰胆管联合刷检诊断壶腹部恶性肿瘤的病理阳性检出率为70.0%（7/10），单独行胆管刷检的病理阳性检出率为22.4%（11/49），两组患者病理阳性检出率比较，差异有统计学意义（P < 0.05）；两组患者胆红素下降幅度比较，差异无统计学意义（P > 0.05）；胆管刷检组发生3例术后并发症，胰胆管联合刷检组无术后并发症发生。结论 与单独行胆管刷检相比，胰胆管联合刷检更有助于诊断壶腹部恶性肿瘤，且不会增加并发症的发生率。值得临床推广应用。

Abstract:

Objective To investigate the clinical application value of combined pancreaticobiliary brushing under endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of hepatopancreatic ampulla malignant tumours.Methods We retrospectively analyzed 59 patients from January 2013 to December 2023 for ERCP treatment of hepatopancreatic ampulla tumours, and performed combined pancreaticobiliary brushing (combined pancreaticobiliary brushing group, n = 10) and biliary duct brushing alone (biliary duct brushing group, n = 49) respectively, then compared the positive pathological detection rate of hepatopancreatic ampulla malignant tumours, the magnitude of bilirubin reduction, and the occurrence of postoperative complications between the two groups.Results The positive detection rate of combined pancreaticobiliary brushing for diagnosing ampulla malignant tumours was 70.0% (7/10), and the positive detection rate of biliary duct brushing alone was 22.4% (11/49), and the positive detection rate of pathology in the two groups was statistically significant (P < 0.05); No significant statistical difference was observed in the decrease of bilirubin between the two groups (P > 0.05); There were three cases of post-operative complications in the biliary duct brushing group. There were no postoperative complications in the combined pancreaticobiliary brushing group.Conclusion Compared with bile duct brushing alone, combined pancreaticobiliary brushing is more helpful for the diagnosis of malignant tumours, and does not increase the incidence of complications. It is worthy for clinical application.