Kim H J, Kim M H, Lee S K, Yoo K S, Seo D W, Min Y I
Department of Internal Medicine, Myongji Hospital, College of Medicine, Kwandong University, Koyang, Korea.
Gastrointest Endosc. 2000 Nov;52(5):635-8. doi: 10.1067/mge.2000.108969.
An irregularly dilated and tortuous vessel, the so-called tumor vessel, is considered to be one of the cholangioscopic features that suggest biliary malignancy. This is a prospective analysis of the presence of a tumor vessel as a finding that discriminates between benign and malignant biliary strictures.
From August 1997 to August 1998, a total of 63 patients with biliary strictures diagnosed with endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography obtained during percutaneous transhepatic biliary drainage tube placement were included in this study. Strictures were characterized as benign or malignant based on the observation of tumor vessels. The results were compared with those of percutaneous transhepatic cholangiography-guided biopsy and final diagnosis.
Forty-one patients were confirmed to have malignant strictures and 22 had benign biliary strictures. Cancer was confirmed by histopathologic evaluation of biopsies in 33 of 41 patients with malignancy (80.4%). Tumor vessel was seen in 25 of 41 patients with malignancy (61%). No patients with benign stricture had tumor vessels. Of the 8 patients with negative percutaneous transhepatic cholangioscopy-guided biopsies but with a final diagnosis of malignancy, 6 had tumor vessels. Combining the observation of tumor vessel and percutaneous transhepatic cholangiography-guided biopsy resulted in a diagnosis of malignancy in 39 of 41 patients (96%) and significantly increased the rate of preoperative diagnosis when compared with percutaneous transhepatic cholangiography-guided biopsy or presence of tumor vessel alone (p<0.05).
The presence of tumor vessel may be a valuable cholangioscopic finding that indicates the presence of a malignant biliary stricture. The combination of tumor vessel observation and percutaneous transhepatic cholangiography-guided biopsy may improve the preoperative diagnosis of malignancy.
一种不规则扩张且迂曲的血管，即所谓的肿瘤血管，被认为是提示胆管恶性肿瘤的胆管镜特征之一。这是一项关于肿瘤血管存在情况的前瞻性分析，该发现可用于鉴别良性和恶性胆管狭窄。
1997年8月至1998年8月，本研究纳入了63例经内镜逆行胆管造影或经皮经肝胆管造影诊断为胆管狭窄的患者，这些造影是在经皮经肝胆道引流管置入过程中获得的。根据肿瘤血管的观察结果将狭窄分为良性或恶性。将结果与经皮经肝胆管造影引导下活检及最终诊断结果进行比较。
41例患者被确诊为恶性狭窄，22例为良性胆管狭窄。41例恶性患者中33例（80.4%）经活检组织病理学评估确诊为癌症。41例恶性患者中有25例（61%）可见肿瘤血管。良性狭窄患者均未见肿瘤血管。8例经皮经肝胆管镜引导下活检阴性但最终诊断为恶性的患者中，6例有肿瘤血管。将肿瘤血管观察结果与经皮经肝胆管造影引导下活检相结合，41例患者中有39例（96%）被诊断为恶性，与单独的经皮经肝胆管造影引导下活检或肿瘤血管存在情况相比，术前诊断率显著提高（p<0.05）。
肿瘤血管的存在可能是一项有价值的胆管镜表现，提示存在恶性胆管狭窄。肿瘤血管观察与经皮经肝胆管造影引导下活检相结合可能会改善恶性肿瘤的术前诊断。
