内镜逆行途径失败后经皮经肝胆道腔内钳取活检术用于胆管狭窄患者：一项回顾性研究
Percutaneous transhepatic intraluminal forceps biopsy for patients with biliary stricture after endoscopic retrograde approach failure: a retrospective study.
作者信息
Liu Yiming, Zhou Xueliang, Kong Lingjian, Han Xinwei, Jiao Dechao
机构信息
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Quant Imaging Med Surg. 2023 Apr 1;13(4):2605-2619. doi: 10.21037/qims-22-915. Epub 2023 Mar 10.
BACKGROUND
The etiological diagnosis of biliary stricture remains a clinical challenge. Currently, endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary biopsy is the most commonly used technique. This retrospective study aimed to evaluate the clinical value of percutaneous transhepatic intraluminal forceps biopsy (TIFB) in patients with biliary stricture after ERCP failure.
METHODS
The clinical data of 240 consecutive patients with biliary strictures who sought further etiologic diagnosis at our center between April 2014 and January 2020 were collected. After the exclusion of 197 patients who underwent ERCP-guided biopsy, 43 patients who received TIFB after ERCP failure were included in the study. The primary outcomes were technical success, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Secondary outcomes included procedure duration, radiation exposure, liver function [total bilirubin (TB), direct bilirubin (DB), γ-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)] preoperatively and at 2 weeks postoperatively, and complications.
RESULTS
The technical success rate of TIFB was 100%. The diagnostic sensitivity, specificity, accuracy, PPV, and NPV of TIFB were 82.35%, 100%, 86.05%, 100%, and 60%, respectively. The accuracy of TIFB was significantly higher for cases with suspicious biliary tract invasion on imaging and intrabiliary malignant origin than it did for cases with no suspicious biliary tract invasion on imaging or extrabiliary malignant origin (P=0.007 and P=0.003, respectively). Only intrabiliary malignant origin (P=0.02) was an independent contributing factor for a true positive result in TIFB diagnosis. The mean procedure duration was 19.3 minutes and the mean radiation exposure was 315.6 mGy. All liver function markers were significantly reduced after 2 weeks (all P<0.001). Three (6.97%) complications occurred, including 1 (2.33%) case of cholangitis and 2 (4.65%) cases of hemobilia.
CONCLUSIONS
Percutaneous TIFB is an effective method with high sensitivity and accuracy for the etiological diagnosis of biliary stricture after ERCP failure.
背景
胆管狭窄的病因诊断仍然是一项临床挑战。目前，内镜逆行胰胆管造影（ERCP）引导下的胆管活检是最常用的技术。本回顾性研究旨在评估经皮经肝胆管腔内钳取活检（TIFB）在ERCP失败的胆管狭窄患者中的临床价值。
方法
收集2014年4月至2020年1月期间在本中心寻求进一步病因诊断的240例连续性胆管狭窄患者的临床资料。排除197例行ERCP引导下活检的患者后，43例ERCP失败后接受TIFB的患者纳入研究。主要结局指标为技术成功率、敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。次要结局指标包括手术时间、辐射暴露、术前及术后2周的肝功能[总胆红素（TB）、直接胆红素（DB）、γ-谷氨酰转移酶（GGT）、碱性磷酸酶（ALP）、丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）]以及并发症。
结果
TIFB的技术成功率为100%。TIFB的诊断敏感性、特异性、准确性、PPV和NPV分别为82.35%、100%、86.05%、100%和60%。对于影像学上有可疑胆道侵犯及胆管内恶性起源的病例，TIFB的准确性显著高于影像学上无可疑胆道侵犯或胆管外恶性起源的病例（分别为P = 0.007和P = 0.003）。仅胆管内恶性起源（P = 0.02）是TIFB诊断真阳性结果的独立影响因素。平均手术时间为19.3分钟，平均辐射暴露为315.6 mGy。术后2周所有肝功能指标均显著降低（均P < 0.001）。发生3例（6.97%）并发症，包括1例（2.33%）胆管炎和2例（4.65%）胆道出血。
结论
经皮TIFB是ERCP失败后胆管狭窄病因诊断的一种有效方法，具有较高的敏感性和准确性。
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