【作者】 周军；

【导师】 王峰；

【作者基本信息】 大连医科大学 ， 影像医学与核医学， 2006， 硕士

【摘要】 目的:通过对怀疑恶性梗阻性黄疸患者行经PTCD通道钳夹活检及毛刷活检,取得组织病理学诊断来分析该方法在恶性梗阻性黄疸病因的诊断价值。方法:2005年4月至2006年4月,因梗阻性黄疸接受经皮肝穿胆道引流(PTCD)和胆道内支架置入术治疗的连续24例患者,其中有4例胆道支架置入后再狭窄的患者,行PTCD同时用钳夹、毛刷两种方法活检行组织病理学检查。得到组织病理学结果,进行对比分析,评价其诊断价值。结果:24例患者接受钳夹活检,其中14例患者同时接受毛刷活检。24例患者钳夹活检均获得病变组织块,钳夹组织的成功率100%,其中,腺癌15例;查到异型细胞4例,怀疑为恶性病变;炎性组织2例,均为支架置入术后再狭窄病例,其中一例查到少许异型细胞;纤维组织1例;3例取得组织为胆管上皮,1例临床诊断为胃癌术后胰头周围淋巴结转移,另2例为胆管癌患者,活检敏感率为79.2%。4例支架置入术后再狭窄的患者组织病理学结果为:炎性组织2例,其中1例有少许异型细胞,腺癌2例。14例毛刷组织细胞学检查,2例查出瘤细胞,2例查出异型细胞,敏感率为28.5%,其余均为阴性结果。结论:经PTCD胆管内活检简单、安全,并发症少,准确率高,钳夹组织的成功率高,创伤小,在行PTCD引流减黄治疗的同时可得到病理学的诊断,为下一步治疗提供病理学依据。更多还原

【Abstract】 Objective : To evaluate percutaneous transhepatic forceps and brush biopsy in patients suspected of having a malignant biliary obstruction.Methods : There were 21cases of obstructive jaundice, male 14 cases,female 10 cases,40-93 years old, mean 69.2years old. All the patients in this study underwent percutaneous transhepatic forceps and brush biopsy during PTCD. In each patient ,two to three specimens were taken from the lesion with biopsy foeceps.Results : The forceps biopsy was performed in all cases., the brush biopcy was performed in 14 cases at same time. Nineteen of twenty four patients resulted in a cancer diagnosis. Adenocarcinoma was found in 15cases ;atypia was found in 4 cases; inflammatory was found in 2 cases. The others were negative. 4 positive results were find in brush biopsy. The sensitivity rate of forceps biopsy was 79.2%; and the sensetivity rate of brush was 28.5% .No major complications related to the biopsy and brush procedures occurred.Conclusion : Percutaneous transhepatic forceps and brush biopsy is a safe procedure that is easy to perform .It provides relatively high accuracy in the diagnosis of malignant biliary obstructions.更多还原