中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2013年
9期
698-702
,共5页
李臻%李腾飞%周进学%韩新巍
李臻%李騰飛%週進學%韓新巍
리진%리등비%주진학%한신외
梗阻性黄疸%经皮肝穿刺胆管造影术%病理学检查%钳夹活组织检查术
梗阻性黃疸%經皮肝穿刺膽管造影術%病理學檢查%鉗夾活組織檢查術
경조성황달%경피간천자담관조영술%병이학검사%겸협활조직검사술
Obstructive jaundice%Percutaneous transhepatic cholangiography%Pathological examination%Biopsy
目的 探讨PTC下胆管钳夹活组织检查(PTCB)对梗阻性黄疸的诊断价值.方法 回顾性分析2001年4月至2011年12月郑州大学第一附属医院连续收治的826例接受PTCB的梗阻性黄疸患者的临床资料,统计病理学结果、PTCB阳性率及并发症等.总结PTCB的安全性、可行性及导致梗阻性黄疸的恶性肿瘤的病理学特点.PTCB对于胆道系统与非胆道系统恶性肿瘤活组织检查阳性率的差异分析采用x2检验.结果 826例梗阻性黄疸患者行PTCB,成功率为100％.术后86例患者出现并发症,其中一过性胆汁血症47例,胆汁漏11例,暂时性胆道出血28例,无严重并发症发生.恶性胆管狭窄740例,良性胆管狭窄86例.PTCB阳性者727例(包括癌性狭窄641例、胆道炎性或纤维增生86例),假阴性99例,总体阳性率为88.01％ (727/826).胆道梗阻因素中,恶性肿瘤占89.59％(740/826).病理检查结果示高、中、低分化癌所占比例分别为57.88％(371/641)、19.97％(128/641)和22.15％(142/641),其中腺癌占96.41％(618/641).胆道系统恶性肿瘤与非胆道系统恶性肿瘤PTCB阳性率分别为89.50％(469/524)和79.63％(172/216),两者比较,差异有统计学意义(x2=12.87,P＜0.05).结论 PTCB对梗阻性黄疸病理学诊断阳性率高,临床应用安全可行.胆源性肿瘤是PTCB的最佳适应证.导致梗阻性黄疸的恶性肿瘤的主要病理类型为高分化腺癌.
目的 探討PTC下膽管鉗夾活組織檢查(PTCB)對梗阻性黃疸的診斷價值.方法 迴顧性分析2001年4月至2011年12月鄭州大學第一附屬醫院連續收治的826例接受PTCB的梗阻性黃疸患者的臨床資料,統計病理學結果、PTCB暘性率及併髮癥等.總結PTCB的安全性、可行性及導緻梗阻性黃疸的噁性腫瘤的病理學特點.PTCB對于膽道繫統與非膽道繫統噁性腫瘤活組織檢查暘性率的差異分析採用x2檢驗.結果 826例梗阻性黃疸患者行PTCB,成功率為100％.術後86例患者齣現併髮癥,其中一過性膽汁血癥47例,膽汁漏11例,暫時性膽道齣血28例,無嚴重併髮癥髮生.噁性膽管狹窄740例,良性膽管狹窄86例.PTCB暘性者727例(包括癌性狹窄641例、膽道炎性或纖維增生86例),假陰性99例,總體暘性率為88.01％ (727/826).膽道梗阻因素中,噁性腫瘤佔89.59％(740/826).病理檢查結果示高、中、低分化癌所佔比例分彆為57.88％(371/641)、19.97％(128/641)和22.15％(142/641),其中腺癌佔96.41％(618/641).膽道繫統噁性腫瘤與非膽道繫統噁性腫瘤PTCB暘性率分彆為89.50％(469/524)和79.63％(172/216),兩者比較,差異有統計學意義(x2=12.87,P＜0.05).結論 PTCB對梗阻性黃疸病理學診斷暘性率高,臨床應用安全可行.膽源性腫瘤是PTCB的最佳適應證.導緻梗阻性黃疸的噁性腫瘤的主要病理類型為高分化腺癌.
목적 탐토PTC하담관겸협활조직검사(PTCB)대경조성황달적진단개치.방법 회고성분석2001년4월지2011년12월정주대학제일부속의원련속수치적826례접수PTCB적경조성황달환자적림상자료,통계병이학결과、PTCB양성솔급병발증등.총결PTCB적안전성、가행성급도치경조성황달적악성종류적병이학특점.PTCB대우담도계통여비담도계통악성종류활조직검사양성솔적차이분석채용x2검험.결과 826례경조성황달환자행PTCB,성공솔위100％.술후86례환자출현병발증,기중일과성담즙혈증47례,담즙루11례,잠시성담도출혈28례,무엄중병발증발생.악성담관협착740례,량성담관협착86례.PTCB양성자727례(포괄암성협착641례、담도염성혹섬유증생86례),가음성99례,총체양성솔위88.01％ (727/826).담도경조인소중,악성종류점89.59％(740/826).병리검사결과시고、중、저분화암소점비례분별위57.88％(371/641)、19.97％(128/641)화22.15％(142/641),기중선암점96.41％(618/641).담도계통악성종류여비담도계통악성종류PTCB양성솔분별위89.50％(469/524)화79.63％(172/216),량자비교,차이유통계학의의(x2=12.87,P＜0.05).결론 PTCB대경조성황달병이학진단양성솔고,림상응용안전가행.담원성종류시PTCB적최가괄응증.도치경조성황달적악성종류적주요병리류형위고분화선암.
Objective To investigate the value of percutaneous transhepatic cholangiobiopsy (PTCB) in the diagnosis of obstructive jaundice.Methods The clinical data of 826 patients with obstructive jaundice who received PTCB at the First Affiliated Hospital of Zhengzhou University from April 2001 to December 2011 were retrospectively analyzed.The pathological results,positive rates of PTCB and complications were analyzed.The safety and efficacy of PTCB and the pathological features of malignancy causing obstructive jaundice were summarized.The difference in the positive rates of PTCB for biliary and non-biliary malignancies was analyzed by chi-square test.Results A total of 826 patients received PTCB,and the success rate was 100％.Eighty-six patients had complications postoperatively,including transit bilhaemia in 47 patients,bile leakage in 11 patients,temporary biliary hemorrhage in 28 patients,no severe complications occurred.There were 740 patients were with malignant biliary stricture and 86 with benign biliary stricture.Seven Hundred and twenty-seven patients were with positive results of PTCB (641 were with cancerous stricture and 86 with inflammation of biliary tract or fibrogenesis),and 99 patients were with false negative results.The overall positive rate of PTCB was 88.01％ (727/826).Malignant neoplasm accounted for 89.59％ (740/826) of the factors causing obstructive jaundice,and well-,moderate-and poor-differentiated neoplasms were accounted for 57.88％ (371/641),19.97％ (128/641) and 22.15％ (142/641).Biliary adenocarcinoma was the main pathologic type,which was accounted for 96.41％ (618/641).The positive rates of PTCB for biliary and non-biliary neoplasms were 89.50％ (469/524)and 79.63％ (172/216),with significant difference (x2 =12.87,P ＜ 0.05).Conclusions PTCB is a safe,feasible and easy way to diagnose obstructive jaundice.Biliary neoplasms are the best indications for PTCB.Well differentiated neoplasm is the main pathological type causing the obstructive jaundice.
