经皮肝穿胆管内钳夹组织活检及毛刷细胞学检查对梗阻性黄疸病因的诊断价值
|
摘要
目的:通过对怀疑恶性梗阻性黄疸患者行经PTCD通道钳夹活检及毛刷活检,取得组织病理学诊断来分析该方法在恶性梗阻性黄疸病因的诊断价值。
方法:2005年4月至2006年4月,因梗阻性黄疸接受经皮肝穿胆道引流(PTCD)和胆道内支架置入术治疗的连续24例患者,其中有4例胆道支架置入后再狭窄的患者,行PTCD同时用钳夹、毛刷两种方法活检行组织病理学检查。得到组织病理学结果,进行对比分析,评价其诊断价值。
结果:24例患者接受钳夹活检,其中14例患者同时接受毛刷活检。24例患者钳夹活检均获得病变组织块,钳夹组织的成功率100%,其中,腺癌15例;查到异型细胞4例,怀疑为恶性病变;炎性组织2例,均为支架置入术后再狭窄病例,其中一例查到少许异型细胞;纤维组织1例;3例取得组织为胆管上皮,1例临床诊断为胃癌术后胰头周围淋巴结转移,另2例为胆管癌患者,活检敏感率为79.2%。4例支架置入术后再狭窄的患者组织病理学结果为:炎性组织2例,其中1例有少许异型细胞,腺癌2例。14例毛刷组织细胞学检查,2例查出瘤细胞,2例查出异型细胞,敏感率为28.5%,其余均为阴性结果。
结论:经PTCD胆管内活检简单、安全,并发症少,准确率高,钳夹组织的成功率高,创伤小,在行PTCD引流减黄治疗的同时可得到病理学的诊断,为下一步治疗提供病理学依据。
Objective : To evaluate percutaneous transhepatic forceps and brush biopsy in patients suspected of having a malignant biliary obstruction.
Methods : There were 21cases of obstructive jaundice, male 14 cases,female 10 cases,40-93 years old, mean 69.2years old. All the patients in this study underwent percutaneous transhepatic forceps and brush biopsy during PTCD. In each patient ,two to three specimens were taken from the lesion with biopsy foeceps.
Results : The forceps biopsy was performed in all cases., the brush biopcy was performed in 14 cases at same time. Nineteen of twenty four patients resulted in a cancer diagnosis. Adenocarcinoma was found in 15cases ;atypia was found in 4 cases; inflammatory was found in 2 cases. The others were negative. 4 positive results were find in brush biopsy. The sensitivity rate of forceps biopsy was 79.2%; and the sensetivity rate of brush was 28.5% .No major complications related to the biopsy and brush procedures occurred.
Conclusion : Percutaneous transhepatic forceps and brush biopsy is a safe procedure that is easy to perform .It provides relatively high accuracy in the diagnosis of malignant biliary obstructions.
方法:2005年4月至2006年4月,因梗阻性黄疸接受经皮肝穿胆道引流(PTCD)和胆道内支架置入术治疗的连续24例患者,其中有4例胆道支架置入后再狭窄的患者,行PTCD同时用钳夹、毛刷两种方法活检行组织病理学检查。得到组织病理学结果,进行对比分析,评价其诊断价值。
结果:24例患者接受钳夹活检,其中14例患者同时接受毛刷活检。24例患者钳夹活检均获得病变组织块,钳夹组织的成功率100%,其中,腺癌15例;查到异型细胞4例,怀疑为恶性病变;炎性组织2例,均为支架置入术后再狭窄病例,其中一例查到少许异型细胞;纤维组织1例;3例取得组织为胆管上皮,1例临床诊断为胃癌术后胰头周围淋巴结转移,另2例为胆管癌患者,活检敏感率为79.2%。4例支架置入术后再狭窄的患者组织病理学结果为:炎性组织2例,其中1例有少许异型细胞,腺癌2例。14例毛刷组织细胞学检查,2例查出瘤细胞,2例查出异型细胞,敏感率为28.5%,其余均为阴性结果。
结论:经PTCD胆管内活检简单、安全,并发症少,准确率高,钳夹组织的成功率高,创伤小,在行PTCD引流减黄治疗的同时可得到病理学的诊断,为下一步治疗提供病理学依据。
Objective : To evaluate percutaneous transhepatic forceps and brush biopsy in patients suspected of having a malignant biliary obstruction.
Methods : There were 21cases of obstructive jaundice, male 14 cases,female 10 cases,40-93 years old, mean 69.2years old. All the patients in this study underwent percutaneous transhepatic forceps and brush biopsy during PTCD. In each patient ,two to three specimens were taken from the lesion with biopsy foeceps.
Results : The forceps biopsy was performed in all cases., the brush biopcy was performed in 14 cases at same time. Nineteen of twenty four patients resulted in a cancer diagnosis. Adenocarcinoma was found in 15cases ;atypia was found in 4 cases; inflammatory was found in 2 cases. The others were negative. 4 positive results were find in brush biopsy. The sensitivity rate of forceps biopsy was 79.2%; and the sensetivity rate of brush was 28.5% .No major complications related to the biopsy and brush procedures occurred.
Conclusion : Percutaneous transhepatic forceps and brush biopsy is a safe procedure that is easy to perform .It provides relatively high accuracy in the diagnosis of malignant biliary obstructions.
引文
1 De Palma GD, Galloro G, Siciliano S, et al. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study [J]. Gastrointest Endosc, 2001, 53(6): 547-553.
2 Hall-Craggs MA, Lees WR. Fine-needle aspiration biopsy: pancreatic and biliary tumors[J]. AJR Am J Roentgenol, 1986, 147(2): 399-403.
3 Chitwood WR Jr, Meyers WC, Heaston DK, et al. Diagnosis and treatment of primary extrahepatic bile duct tumors[J]. Am J Surg, 1982, 143(1): 99-106.
4 Evander A, Fredlund P, Hoevels J, Ihse I, Bengmark S. Evaluation of aggressive surgery for carcinoma of the extrahepatic bile ducts [J]. Ann surg, 1980, 191(1): 23-29.
5 Jung GS, Huh JD, Lee SU, et al. Bile duct: analysis of percutaneous transluminal forceps biopsy in 130 patients suspected of having malignant biliary obstruction[J].Radiology, 2002, 224(3): 725-730.
6 韩新巍,李永东,马波,等。阻塞性黄疸经皮肝穿胆管造影术下胆管钳夹活检病理学诊断[J]. 中华放射学杂志, 2004,38(10): 1025-1029.
7 Sato M, Inoue H, Ogawa S, et al. Limitations of percutaneous transhepatic cholangioscopy for the diagnosis of the intramural extension of bile duct carcinoma[J]. Endoscopy, 1998, 30(3):281-288.
8 Terasaki K, Wittich GR, Lycke G, et al. Percutaneous transluminal biopsy of biliary strictures with a bioptome[J]. AJR Am J Roentgenol, 1991, 156(1):77-78.
9 Kim CS, Han YM, Song HY, et al. Pecutaneous transhepatic biliary biopsy using gastrofiberscopic biopsy forceps[J]. J Korean Med Sci, 1992; 7(4):325-332.
10 Donald JJ, Fache JS, Burhenne HJ. Percutaneous transluminal biopsy of the biliary tract[J]. Can Assoc Radiol J, 1993, 44(3):185-188.
11 Tsai CC, Mo LR, Chou CY, et al. Percutanuous transhepatic transluminal forceps biopsy in obstructive jaundice[J]. Hepatogastroenterology,1997, 44(15):770-773.
12 Macken E, Drijkoningen M, Van Aken E, Van Steenbergen W. Brush cytology of ductal strictures during ERCP. Acta Gastroenterologica Belgica2000;LXIII:254-9.
13 Jailwala J, Fogel EL, Sherman S, Gotttlieb K, Flueckiger J, Bucksot LG, et al. Triple tissue sampling at ERCP in malignant biliary obstruction. Gastrointest Endosc 2000;51:383-90.
1. EditorialS. Diagnosis of cancer by cytologic methods performed during ETCP. Gastrointest Endosc,1994;40(2):249
2. Mohandas KM, Swaroop VS, Gullar SU, et al. Diagnosis of malignant obstructive jaundice by bile cytology; improved results by dilatating the bile duct stricture. Gastrointest Endosc, 1994; 40: 150
3. Jin YH, Kim SH, Park CK. Diagnostic criteria for malignancy in bile cytology and its usefulness. J Korean Med Sci 1999; 15:643-7.
4. Osnes M, Serck-Hanssen A, Myren J. Endoscopic retrograd brush cytology (ERBC) of the biliary and pancreatic ducts. Scand J Gastroenterol 1975;10:829-31.
5. Mendez A Jr, Russel E, Levi JU, Koolpe H, Cohen. Percutaneous brush biopay and internal drainage of biliary through endoprosthesis. American Journal of Radiology 1975;134:653-9.
6. 屠金夫,王炳生,焦宛. 胆汁脱落细胞、刷取细胞检查和钳取组织活检对恶性胆道病变的诊断价值, 中国实用外科杂志,1997,17(2),107-108
7. Jung GS, Huh JD, Lee SU, et al. Bile duct; analysis of percutaneous transluminal forceps biopsy in 130 patients suspected of having malignant biliary obstruction. 2002, 224; 725-729
8. 韩新巍,李永东,高雪梅,等。经皮肝穿刺胆道造影术下胆管活检的临床研究. 介入放射学杂志, 2002,11:351-353
9. Guiband L, Bret PM, Reinhold C, et al. Bile duct obstruction and choledocholithiasis : diagnosis with MR cholangigraphy. Radiology, 1995, 197; 109-112
10. 赵荣国, 陆星华,冯逢,等. 胰胆管疾病的磁共振胰胆管成像与内镜逆行胰胆管造影初步对照研究. 中华放射学杂志, 1997, 31: 657-662
11. 张雪哲, 卢延,主编. CT,MRI 介入放射学. 第二版.北京;科学出版社,2001, 54-90
12. Ponchon T, Gagnon F, Berger F, Labadie M, Liaras A, Chavaillon A, et alValue of endobiliary bursh cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospecttive study, Gastrointest Endosc 1995;42:565-72.
13. Kocjan G, Smith AN. Bile duct brush cytology: potemtial pitfalls indiagnoses. Diagn Cytopathol 1997;16:358-63.
14. Logrono R, Kurtycz DF, Molina CP,Trivedi VA, Wong JK,Block KP. Analysis of false-negative diagnoses on endoscopic brush cytology of biliary and pancreatic duct strictures. The experience at 2 University Hospitals. Arch Pathol Lab Med 2000;124:387-92.
15. Ferrari AP Jr,Linchtenstein DR, Slivka A, Chang C, Carrlocke D. Brushcytology during EPCP for the diagnosis of biliary and pancreatic malignancies. Gastrointest Endosc 1994;40:140-5.
16. Mansfield JC, Griffin SM, Wadebra V, Matthewson K. A prospective evaluation of cytology from biliaty strictures. Gut 1997;49:671-7.
17. Layfield LJ, Wax TD, LeeJG, Cotton PB. Accuracy and morphologic aspects of pancreatic and biliary ducts brushings. Acta Cytologica 1995;39:11-8.
18. Arbores Saavedra J, Henson DE, Sobin LH. The WHO histological calssification of tumors of the gallbaldder and extrahepatic bile ducts. A commentary on the second edition. Cancer 1992;70:410-4.
19. Cohen MB, WittchowRJ, Johlin FC, Bottles K, Raab SS. Brush cytology of the extrahepatic biliary tract: comparison of cytologic features of adenocarcinoma and benign biliary strictures. Mod Pathol 1995;8:498-502.
20. Logrono R, Waxman I. Interactive role of the cytopathologist in ERS guided fine needle aspiration:an efficient approach. Gastrointest Endosc 2001;54:485-90.
21. Stewart CJR, Mills PR, Garter R, O’Donohue J, Fullarton G, Imrie CW, et al. Brushu cytology in the assessment of pancreatico-biliary strictures: a review of 406 cases. J Clin Pathol 2001;54:449-55.
22. Lee JG, Leung JW, Baillie J, Layfield LJ, Cotton PB. Benign, dysplastic, or malignant-making sense of endoscopic bile duct brush cytology: results in 149consecutive patients. AmJ Gastroenterol1995;90:722-6.
2 Hall-Craggs MA, Lees WR. Fine-needle aspiration biopsy: pancreatic and biliary tumors[J]. AJR Am J Roentgenol, 1986, 147(2): 399-403.
3 Chitwood WR Jr, Meyers WC, Heaston DK, et al. Diagnosis and treatment of primary extrahepatic bile duct tumors[J]. Am J Surg, 1982, 143(1): 99-106.
4 Evander A, Fredlund P, Hoevels J, Ihse I, Bengmark S. Evaluation of aggressive surgery for carcinoma of the extrahepatic bile ducts [J]. Ann surg, 1980, 191(1): 23-29.
5 Jung GS, Huh JD, Lee SU, et al. Bile duct: analysis of percutaneous transluminal forceps biopsy in 130 patients suspected of having malignant biliary obstruction[J].Radiology, 2002, 224(3): 725-730.
6 韩新巍,李永东,马波,等。阻塞性黄疸经皮肝穿胆管造影术下胆管钳夹活检病理学诊断[J]. 中华放射学杂志, 2004,38(10): 1025-1029.
7 Sato M, Inoue H, Ogawa S, et al. Limitations of percutaneous transhepatic cholangioscopy for the diagnosis of the intramural extension of bile duct carcinoma[J]. Endoscopy, 1998, 30(3):281-288.
8 Terasaki K, Wittich GR, Lycke G, et al. Percutaneous transluminal biopsy of biliary strictures with a bioptome[J]. AJR Am J Roentgenol, 1991, 156(1):77-78.
9 Kim CS, Han YM, Song HY, et al. Pecutaneous transhepatic biliary biopsy using gastrofiberscopic biopsy forceps[J]. J Korean Med Sci, 1992; 7(4):325-332.
10 Donald JJ, Fache JS, Burhenne HJ. Percutaneous transluminal biopsy of the biliary tract[J]. Can Assoc Radiol J, 1993, 44(3):185-188.
11 Tsai CC, Mo LR, Chou CY, et al. Percutanuous transhepatic transluminal forceps biopsy in obstructive jaundice[J]. Hepatogastroenterology,1997, 44(15):770-773.
12 Macken E, Drijkoningen M, Van Aken E, Van Steenbergen W. Brush cytology of ductal strictures during ERCP. Acta Gastroenterologica Belgica2000;LXIII:254-9.
13 Jailwala J, Fogel EL, Sherman S, Gotttlieb K, Flueckiger J, Bucksot LG, et al. Triple tissue sampling at ERCP in malignant biliary obstruction. Gastrointest Endosc 2000;51:383-90.
1. EditorialS. Diagnosis of cancer by cytologic methods performed during ETCP. Gastrointest Endosc,1994;40(2):249
2. Mohandas KM, Swaroop VS, Gullar SU, et al. Diagnosis of malignant obstructive jaundice by bile cytology; improved results by dilatating the bile duct stricture. Gastrointest Endosc, 1994; 40: 150
3. Jin YH, Kim SH, Park CK. Diagnostic criteria for malignancy in bile cytology and its usefulness. J Korean Med Sci 1999; 15:643-7.
4. Osnes M, Serck-Hanssen A, Myren J. Endoscopic retrograd brush cytology (ERBC) of the biliary and pancreatic ducts. Scand J Gastroenterol 1975;10:829-31.
5. Mendez A Jr, Russel E, Levi JU, Koolpe H, Cohen. Percutaneous brush biopay and internal drainage of biliary through endoprosthesis. American Journal of Radiology 1975;134:653-9.
6. 屠金夫,王炳生,焦宛. 胆汁脱落细胞、刷取细胞检查和钳取组织活检对恶性胆道病变的诊断价值, 中国实用外科杂志,1997,17(2),107-108
7. Jung GS, Huh JD, Lee SU, et al. Bile duct; analysis of percutaneous transluminal forceps biopsy in 130 patients suspected of having malignant biliary obstruction. 2002, 224; 725-729
8. 韩新巍,李永东,高雪梅,等。经皮肝穿刺胆道造影术下胆管活检的临床研究. 介入放射学杂志, 2002,11:351-353
9. Guiband L, Bret PM, Reinhold C, et al. Bile duct obstruction and choledocholithiasis : diagnosis with MR cholangigraphy. Radiology, 1995, 197; 109-112
10. 赵荣国, 陆星华,冯逢,等. 胰胆管疾病的磁共振胰胆管成像与内镜逆行胰胆管造影初步对照研究. 中华放射学杂志, 1997, 31: 657-662
11. 张雪哲, 卢延,主编. CT,MRI 介入放射学. 第二版.北京;科学出版社,2001, 54-90
12. Ponchon T, Gagnon F, Berger F, Labadie M, Liaras A, Chavaillon A, et alValue of endobiliary bursh cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospecttive study, Gastrointest Endosc 1995;42:565-72.
13. Kocjan G, Smith AN. Bile duct brush cytology: potemtial pitfalls indiagnoses. Diagn Cytopathol 1997;16:358-63.
14. Logrono R, Kurtycz DF, Molina CP,Trivedi VA, Wong JK,Block KP. Analysis of false-negative diagnoses on endoscopic brush cytology of biliary and pancreatic duct strictures. The experience at 2 University Hospitals. Arch Pathol Lab Med 2000;124:387-92.
15. Ferrari AP Jr,Linchtenstein DR, Slivka A, Chang C, Carrlocke D. Brushcytology during EPCP for the diagnosis of biliary and pancreatic malignancies. Gastrointest Endosc 1994;40:140-5.
16. Mansfield JC, Griffin SM, Wadebra V, Matthewson K. A prospective evaluation of cytology from biliaty strictures. Gut 1997;49:671-7.
17. Layfield LJ, Wax TD, LeeJG, Cotton PB. Accuracy and morphologic aspects of pancreatic and biliary ducts brushings. Acta Cytologica 1995;39:11-8.
18. Arbores Saavedra J, Henson DE, Sobin LH. The WHO histological calssification of tumors of the gallbaldder and extrahepatic bile ducts. A commentary on the second edition. Cancer 1992;70:410-4.
19. Cohen MB, WittchowRJ, Johlin FC, Bottles K, Raab SS. Brush cytology of the extrahepatic biliary tract: comparison of cytologic features of adenocarcinoma and benign biliary strictures. Mod Pathol 1995;8:498-502.
20. Logrono R, Waxman I. Interactive role of the cytopathologist in ERS guided fine needle aspiration:an efficient approach. Gastrointest Endosc 2001;54:485-90.
21. Stewart CJR, Mills PR, Garter R, O’Donohue J, Fullarton G, Imrie CW, et al. Brushu cytology in the assessment of pancreatico-biliary strictures: a review of 406 cases. J Clin Pathol 2001;54:449-55.
22. Lee JG, Leung JW, Baillie J, Layfield LJ, Cotton PB. Benign, dysplastic, or malignant-making sense of endoscopic bile duct brush cytology: results in 149consecutive patients. AmJ Gastroenterol1995;90:722-6.