经ERCP联合SpyGlass DS治疗的74例不明原因胆管狭窄患者的临床特征分析
Clinical characteristics of 74 patients with indeterminate biliary stricture treated by ERCP combined with SpyGlass DS
马丽娜·阿新拜 1张立平 2王林恒 3王允亮 3陈润花 3孟捷 3胡立明 3姚玉璞3
作者信息
- 1. 北京中医药大学,北京 100029;新疆医科大学中医学院
- 2. 北京中医药大学,北京 100029;北京中医药大学东方医院脾胃肝胆科
- 3. 北京中医药大学东方医院脾胃肝胆科
- 折叠
摘要
目的 分析经内镜逆行胰胆道造影(endoscopic retrograde cholangiopancreatography,ERCP)联合 SpyGlass DS治疗的不明原因胆管狭窄(indeterminate biliary stricture,IBS)患者的临床资料,为 IBS的诊疗提供更多临床数据参考.方法 回顾性分析 2020 年1 月至 2023 年 4 月北京中医药大学东方医院消化内镜中心经 ERCP 联合 SpyGlass DS 治疗的 74 例 IBS患者的临床资料,归纳采用SpyGlass DS直视下视觉印象评估良恶性狭窄的情况,总结 SpyGlass DS引导下视觉印象和 SpyGlass DS 引导下活检(SpyBite 活检)在诊断 IBS的性能特点.结果 共纳入 74 例 IBS 患者,男 49 例,女 25 例,年龄(67±12)岁(26～94 岁).74 例患者中,61 例(82.4%)直视下考虑为恶性狭窄,其中 40 例(65.6%)病理诊断提示恶性,5 例(8.2%)病理诊断未提示恶性,16 例(26.2%)未取活检.随访过程中,有 1 例患者经影像学检查被诊断为恶性肿瘤,而其余患者未发现进展;13 例(17.6%)SpyGlass DS 直视下考虑为良性狭窄,其中 3 例(23.0%)病理诊断恶性,5 例(38.5%)病理诊断未提示恶性,5 例(38.5%)未取活检并在随访过程中均未发现狭窄处进展.SpyGlass DS直视下视觉印象为肿瘤血管、增生物、黏膜不规则/结节性/增生性改变、黏膜损伤、胆管内渗出物的表现而病理诊断提示恶性的占比分别为 24.4%、20.0%、62.2%、2.2%、8.9%.SpyGlass DS直视下视觉印象的敏感度为 88.9%,特异度为 37.5%,准确度为 81.1%,SpyBite活检的诊断敏感度为 95.7%,特异度为 66.7%,准确度为 92.3%.结论 对 IBS 可采用 ERCP联合 SpyGlass DS进行诊断,可大大提高疾病确诊率.
Abstract
Objective To analyze the clinical data of patients with indeterminate biliary stricture(IBS)treated by endoscopic retrograde cholangiopancreatography(ERCP)combined with SpyGlass DS to provide more clinical data ref-erence for the treatment of IBS.Methods To review the clinical data of 74 patients with IBS treated by ERCP combined with SpyGlass DS at the Digestive Endoscopy Center of Dongfang Hospital,Beijing University of Chinese Medicine from Jan.2020 to Apr.2023,analyze the clinical characteristics of patients,summarize the assessment of benign and malig-nant strictures using SpyGlass DS direct visual impression,and summarize the results of SpyGlass DS-guided visual im-pression and SpyGlass DS-guided biopsy(SpyBite biopsy)performance characteristics in the diagnosis of IBS.Results A total of 74 patients with IBS,including 49 males and 25 females,aged(67±12)years(26-94 years),were included in this study.Sixty-one(82.4%)of the 74 patients were considered to have malignant stenosis under direct visualiza-tion,of which 40(65.6%)had a pathological diagnosis suggestive of malignancy,5(8.2%)had a pathological diagno-sis not suggestive of malignancy,and 16(26.2%)were not undergo biopsy.During follow-up,1 patient was diagnosed as malignant by imaging,while no progression was detected in the remaining patients.Thirteen(17.6%)SpyGlass DS stenoses were considered benign under direct visualization,of which 3(23.0%)were pathologically diagnosed as malig-nant,5(38.5%)were not pathologically diagnosed as malignant,and 5(38.5%)were not biopsied and no progres-sion was detected in any of the stenoses during follow-up.The percentage of SpyGlass DS direct visual impressions of tumor vascularity,hyperplasia,mucosal irregularity/nodular/proliferative changes,mucosal injury and biliary exudate with pathological diagnosis suggestive of malignancy were 24.4%,20.0%,62.2%,2.2%and 8.9%,respectively.The diagnostic sensitivity of SpyGlass DS direct visual impressions was 88.9%,with a specificity of 37.5%and accuracy of 81.1%,and the diagnostic sensitivity of SpyBite biopsy was 95.7%,with a specificity of 66.7%and accuracy of 92.3%.Conclusion ERCP combined with SpyGlass DS can be used for the diagnosis of IBS,which can greatly im-prove the disease confirmation rate.
关键词
不明原因胆管狭窄/ERCP/SpyGlass/DS/视觉印象/SpyBite直视活检Key words
Indeterminate biliary stricture/ERCP/SpyGlass DS/Visual impression/SpyBite direct visual biopsy引用本文复制引用
基金项目
北京中医药大学重点攻关项目(2020-JYB-ZDGG-132)
出版年
2024
NETL
NSTL
万方数据