Neuhaus H, Hoffmann W, Classen M
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München.
Dtsch Med Wochenschr. 1993 Apr 23;118(16):574-81. doi: 10.1055/s-2008-1059365.
Percutaneous transhepatic cholangioscopy (PTCS) was undertaken in 101 patients (for diagnostic reasons in 64 and/or therapeutic reasons in 56) out of 167 consecutive patients (56 women, 45 men; mean age 64.2 [27-95] years) in whom percutaneous transhepatic drainage had been instituted. In all but one of 64 patients PTCS clearly defined stenoses which had been unclear in the cholangiogram. There was a 90% accuracy of histological diagnosis of biopsies obtained under vision in 60 cases. A malignant stenosis was seen in 19 of 25 cases (sensitivity 76%). Severe stenosis, not passable by contrast medium, were recanalized cholangioscopically in 14 of 15 cases. Biliary tract stones were completely removed by PTCS in 40 of 41 patients, by mechanical means (n = 4) or intracorporeal lithotripsy (n = 37). There were no complications from PTCS. It is concluded that PTCS can be performed safely and reliably in patients with functioning percutaneous transhepatic drainage. It provides the diagnosis of previously unclear cholangiographic findings as well as treatment of difficult biliary tract stenoses and/or ductal stones.
在167例接受经皮经肝胆道引流术的连续患者（56例女性，45例男性；平均年龄64.2[27 - 95]岁）中，101例患者接受了经皮经肝胆道镜检查（PTCS）（64例用于诊断，56例用于诊断和/或治疗）。在64例患者中，除1例之外，PTCS均明确了胆管造影中不清晰的狭窄部位。60例患者在直视下获取活检组织，组织学诊断准确率达90%。25例中有19例发现恶性狭窄（敏感性76%）。15例造影剂无法通过的严重狭窄患者中，14例经胆道镜再通。41例患者中有40例通过PTCS完全清除了胆道结石，其中4例采用机械方法，37例采用体内碎石术。PTCS无并发症发生。结论是，在有功能良好的经皮经肝胆道引流的患者中，PTCS可以安全可靠地进行。它能对先前不清晰的胆管造影结果进行诊断，并能治疗难治性胆道狭窄和/或胆管结石。
