ERCP联合改良活检钳在疑似恶性胆管狭窄患者诊断中的应用分析（附视频）

Application analysis of ERCP combined with modified biopsy forceps in the diagnosis of patients with suspected malignant biliary stricture (with video)

摘要:

在内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatograph，ERCP）活检实践中发现通过活检钳头端弯折可以改善活检成功率。通过回顾既往手术中使用该改良方法及常规方法取检的病例进行对比，探讨ERCP联合改良活检钳取检在疑似肝外恶性胆管狭窄患者中的诊断价值。将2017年1月至2023年4月72例疑似肝外恶性胆管狭窄行改良活检钳ERCP取检的患者作为改良组，同时期61例常规活检钳ERCP取检的患者为对照组。术中明确狭窄部位且通过活检获得有效的病理组织，结合病史及临床资料回访确定肿瘤良恶性质。对比两组活检方法的敏感度与特异度。两组夹取组织块成功率为100.0%，所有患者均无严重并发症，得到组织学诊断。改良组最终诊断为恶性67例，良性5例；对照组恶性58例，良性3例。改良组诊断恶性胆管狭窄敏感度为79.10%（54/67），对照组诊断恶性胆管狭窄敏感度为60.34%（35/58），两组差异有统计学意义（χ2=6.218，P=0.013）。两组取检方法诊断胆管恶性狭窄的特异度均为100.00%。因此，应用ERCP联合改良活检钳活检诊断肝外恶性胆管狭窄是安全、有效的。

Abstract:

In the practice of endoscopic retrograde cholangiopancreatography (ERCP) biopsy, it was found that the success rate of biopsy could be improved by bending the tip of biopsy forceps. Objective to explore the diagnostic value of ERCP combined with modified biopsy forceps in patients with suspected malignant biliary obstruction by reviewing the cases of previous surgery using the improved method and conventional method. From January 2017 to April 2023, 72 patients with suspected malignant biliary obstruction who underwent biopsy forceps head bending modified ERCP were selected as the modified group, while 61 patients with traditional biopsy forceps ERCP were selected as the control group at the same time. The stenosis site was identified during the operation, and the effective pathological tissue was obtained by biopsy. The benign and malignant nature of the tumor was determined according to the medical history and clinical data. The sensitivity and specificity of the two biopsy methods were compared. The success rate of tissue block clipping was 100.0% in the two groups. All patients had no serious complications and were diagnosed histologically. 67 cases were finally diagnosed as malignant and 5 cases were benign in the improved group; In the control group, 58 cases were malignant and 3 cases were benign. The sensitivity of the improved group in diagnosing malignant biliary stricture was 79.10% (54 / 67), and the overall sensitivity of biopsy in the control group was 60.34% (35 / 58), with significant difference (χ2=6.218, P = 0.013). The specificity of the two methods in the diagnosis of malignant stenosis was 100.00%. Therefore, it is a safe and effective method to apply the modified bending method of biopsy forceps in the diagnosis of extrahepatic malignant bile duct stenosis by ERCP biopsy.