Hwang M H, Tsai C C, Chou C Y, Mo L R, Yang C T, Lin R C, Yueh S K
Department of Surgery, Show-Chwan Memorial Hospital, Chang-Hua, Taiwan, ROC.
Hepatogastroenterology. 1998 Nov-Dec;45(24):2073-8.
BACKGROUND/AIMS: The aim of the present study was to determine the usefulness and sensitivity of percutaneous cholangiofiberscopic guided forceps biopsy in patients suspected of intrabile duct diseases. This study also emphasized the use of a video monitor system in which the field of view is magnified; thus, even a small lesion can easily be detected. Furthermore, coordination of both the operator and assistant is easier because both can observe the image together on the video monitor.
Percutaneous cholangio-fiberscopic forceps biopsy was performed in 27 patients (14 men, 13 women, aged 37-81 years with a mean age of 61 years). A mature T-tube tract was used as an access for cholangioscopy in 17 cases while the remaining 10 patients underwent percutaneous transhepatic biliary drainage and gradual tract dilatation from 7-French to 16-French. A flexible fiberoptic choledoscope was gently inserted into a mature tract and once an abnormal mucosal lesion was identified, a forceps biopsy was inserted into a working channel of the scope, and 3-5 specimens were taken for histological examination.
A histological diagnosis was obtained in 24 cases of the 27 patients (sensitivity 89%) and included cholangiocarcinoma (n=8), papillomatosis (n=3), ampullary adenoma (n=1), ampullary adenocarcinoma (n=1), hepatoma with intrabile duct invasion (n=1), and chronic inflammation (n=10). Post-procedural bleeding was noted in 1 patient.
Percutaneous cholangiofiberscopic-guided forceps biopsy is a safe and easy to perform procedure. It yielded a high sensitivity rate for definitive diagnosis of very small or early intrabile duct lesions; thus, a curative therapeutic modality can be appropriately applied. The use of a video monitor system, which magnified the field of view without distorting the quality of the image, plays a crucial role in this technique. Mucin substance is commonly seen in cholangiocarcinoma. The association between bile duct stones and neoplasm needs further evaluation.
背景/目的：本研究的目的是确定经皮胆管纤维镜引导下钳取活检在疑似胆管疾病患者中的实用性和敏感性。本研究还强调了使用视野放大的视频监测系统；因此，即使是小病变也能轻松检测到。此外，由于操作者和助手都可以在视频监视器上一起观察图像，两者之间的协作更容易。
对27例患者（14例男性，13例女性，年龄37 - 81岁，平均年龄61岁）进行了经皮胆管纤维镜钳取活检。17例患者利用成熟的T管窦道作为胆管镜检查的通道，其余10例患者接受经皮肝穿刺胆道引流，并将窦道从7法式逐步扩张至16法式。将可弯曲的纤维光学胆管镜轻轻插入成熟的窦道，一旦发现异常黏膜病变，将活检钳插入镜的工作通道，取3 - 5块标本进行组织学检查。
27例患者中有24例获得了组织学诊断（敏感性89%），包括胆管癌（8例）、乳头状瘤病（3例）、壶腹腺瘤（1例）、壶腹腺癌（1例）、肝内胆管侵犯的肝癌（1例）和慢性炎症（10例）。1例患者术后出现出血。
经皮胆管纤维镜引导下钳取活检是一种安全且易于实施的操作。它对非常小的或早期胆管病变的确诊具有较高的敏感性；因此，可以适当应用根治性治疗方式。使用不扭曲图像质量而放大视野的视频监测系统在该技术中起着关键作用。黏蛋白物质在胆管癌中常见。胆管结石与肿瘤之间的关联需要进一步评估。
