Warnken Eva-Marie, Uder Michael, Stein Hubert, Wucherer Michael, Lell Michael, Muschweck Herbert, Adamus Ralf
Institute of Radiology, Friedrich Alexander University Erlangen, Germany.
Clinic of Visceral- und Thoraxsurgery, Klinikum Nürnberg, Germany.
Z Gastroenterol. 2019 Feb;57(2):133-138. doi: 10.1055/a-0821-7060. Epub 2019 Feb 12.
The goal of this study was to evaluate the experience of 11 years of wire-guided forceps biopsy via PTCD in patients with obstructive jaundice.
In a retrospective approach, 56 biopsies in 51 patients were analyzed (22 female, 29 male). Data was collected from 2006 to 2016. Mean age was 71 years (range: 34 - 86 years). Data was extracted from dig. Patients' records (KIS, PACS, RIS) to be analyzed in Microsoft Excel.
All 56 procedures were technically successful. Stenosis in anastomoses were benign due to scarring in 7 patients and in 9 due to papillitis or others. In 4 patients, results in anastomosis were malignant. In 19 patients without anastomosis, CCC was the diagnosis, thereof 10 klatskin, 9 stenosis in other locations, followed by gastric, pancreatic, and colon carcinoma in 5, 3, and 2 patients. Three patients had a CUP (multimetering in case of more than 1 related category). Overall results were 35 mal. and 16 benign, 76.8 % of all proc. had a correct histopathologic result, and 23.2 % were false negative. Sensitivity was 65.8 %, which results in negative predictive value of 58.1 %. There was no false positive and so specificity was 100 %, as was the positive predictive value. False negative results (no malignancy but clinically and imaging suspect) were corrected by rerunning the procedure, by CT-guided biopsy or by 1 PET-CT. In 1 case the surg. sample brought the result. Minor complications occurred in 8 patients: shivering in 1 case, distinct but hemodynamically not relevant hemobilia in 5 cases, 2 portovenal bleedings. All bleedings were short-term and self-limiting.
Despite good feasibility, low peri- and post-interv. risk and high validity the forceps biopsy via PTCD is not widely used. For experienced interventionalists, it is an effective method for obtaining histology.
本研究的目的是评估经皮经肝胆道引流（PTCD）引导下使用活检钳对梗阻性黄疸患者进行11年活检的经验。
采用回顾性研究方法，分析了51例患者的56次活检（女性22例，男性29例）。收集了2006年至2016年的数据。平均年龄为71岁（范围：34 - 86岁）。数据从数字患者记录（KIS、PACS、RIS）中提取，在Microsoft Excel中进行分析。
所有56例手术在技术上均获成功。吻合口狭窄中，7例因瘢痕形成呈良性，9例因乳头炎或其他原因呈良性。4例患者吻合口结果为恶性。在19例无吻合口的患者中，诊断为胆管癌，其中10例为肝门部胆管癌，9例为其他部位狭窄，其次为胃癌、胰腺癌和结肠癌，分别为5例、3例和2例。3例患者患有未知原发部位肿瘤（多部位时涉及多个相关类别）。总体结果为35例恶性和16例良性，所有操作中有76.8%获得了正确的组织病理学结果，23.2%为假阴性。敏感性为65.8%，阴性预测值为58.1%。无假阳性，因此特异性为100%，阳性预测值也为100%。假阴性结果（无恶性肿瘤但临床和影像学怀疑有）通过重新进行操作、CT引导下活检或1次PET-CT检查得以纠正。1例患者通过手术样本得出结果。8例患者出现轻微并发症：1例寒战，5例出现明显但血流动力学上无相关性的胆道出血，2例门静脉出血。所有出血均为短期且自限性。
尽管经皮经肝胆道引流引导下活检钳活检具有良好的可行性、较低的围手术期和术后风险以及较高的有效性，但并未得到广泛应用。对于经验丰富的介入医生而言，它是获取组织学的有效方法。
