经口胆道镜SpyGlass在肝门部不明原因胆管狭窄诊断中的应用

doi:10.16139/j.1007-9610.2023.04.012

摘要/Abstract

摘要：

目的：探讨SpyGlass胆道镜系统对肝门部不明原因胆管狭窄的诊断价值。方法：回顾性分析2018年1月至2022年12月我院进行内镜逆行胰胆管造影术和SpyGlass检查的肝门部不明原因胆管狭窄，记录SpyGlass下对病灶的视觉印象、直视下活检病理检查、常规细胞刷检等结果。以病理诊断为金标准，结合长期随访结果，比较不同诊断方法的灵敏度、特异度和准确率。结果：共纳入146例，操作成功145例（99.3%），平均操作时间为（51.5±16.9） min。SpyGlass视觉诊断的灵敏度、特异度和准确率分别为83%、84%和83%，优于细胞刷检的47%、100%和52%。视觉诊断联合SpyBite活检的灵敏度、特异度及准确率为91%、63%、85%。不良事件总体发生率为24.7%，均为临床轻型。结论：SpyGlass经口胆道镜对于诊断肝门部不明原因胆管狭窄有较高的准确率和安全性，值得推广应用。

关键词: 肝门部胆管狭窄, 内镜逆行胰胆管造影, SpyGlass, SpyBite

Abstract:

Objective: To investigate the diagnostic value of SpyGlass choledochoscopy system in indeterminate stricture of hilar bile duct. Methods: A retrospective analysis was conducted on 146 patients with indeterminate stricture of the hilar bile duct who underwent endoscopic retrograde cholangio-pancreatography (ERCP) and SpyGlass examinations at our hospital between January 2018 and December 2022. The study recorded the visual impressions of the lesions, direct visualization-guided biopsy pathology, and conventional brush cytology results obtained using SpyGlass system. The sensiti-vity, specificity, and accuracy of different diagnostic methods were compared, taking pathological diagnosis as the gold standard and considering long-term follow-up results as well. Results: Out of the 146 patients, the procedure was successful in 145 cases (99.3%). The average procedure time was （51.5±16.9） min. The sensitivity, specificity, and accuracy of SpyGlass visual impression diagnosis for indeterminate biliary stricture were 83%, 84%, and 83%, respectively, outperforming brush cytology results (47%, 100%, and 52%). The combination of visual diagnosis and SpyBite biopsy yielded sensiti-vity of 91%, specificity of 63%, and accuracy of 85%. Adverse events occurred in 24.7% of cases, all of which were clinically mild. Conclusions: SpyGlass choledochoscopy has a high accuracy and safety in differential diagnosis of indeterminate stricture of the hilar bile duct. Its widespread application is warranted.

Key words: Hilar bile duct stricture, Endoscopic retrograde cholangio-pancreatography, SpyGlass, SpyBite

中图分类号:

R657.4

胡贤荣, 杨档档, 吴军, 赵毅, 陈萃, 张婷, 胡冰. 经口胆道镜SpyGlass在肝门部不明原因胆管狭窄诊断中的应用[J]. 外科理论与实践, 2023, 28(04): 361-365.

HU Xianrong, YANG Dangdang, WU Jun, ZHAO Yi, CHEN Cui, ZHANG Ting, HU Bing. Diagnostic application of SpyGlass in indeterminate stricture of hilar bile duct[J]. Journal of Surgery Concepts & Practice, 2023, 28(04): 361-365.

图/表 2

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Variable	N	Sensitivity (%)	Specificity (%)	Accuracy(%)	Negative predictive value (%)
SpyGlass visual diagnosis (95% CI)	145	0.83 (0.75-0.89)	0.84 (0.69-0.92)	0.83 (0.77-0.89)	0.63 (0.49-0.75)
SpyBite pathological diagnosis (95% CI)	53	0.58 (0.46-0.69)	1.00 (0.81-1.00)	0.66 (0.56-0.76)	0.36 (0.24-0.51)
Intraductal ultrasound examination (95% CI)	17	0.71 (0.45-0.88)	0.67 (0.21-0.98)	0.71 (0.47-0.87)	0.33 (0.10-0.70)
Cytobrush pathological diagnosis (95% CI)	85	0.47 (0.33-0.61)	1.00 (0.57-1.00)	0.52 (0.39-0.65)	0.17 (0.08-0.35)
Spyglass+SpyBite (95% CI)	53	0.91 (0.82-0.96)	0.63 (0.39-0.82)	0.85 (0.76-0.91)	0.63 (0.39-0.82)