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良性胆管狭窄的内镜诊疗现状

原文聪 何桥 王志鑫 樊海宁 王海久 任宾 任利

原文聪, 何桥, 王志鑫, 等. 良性胆管狭窄的内镜诊疗现状[J]. 临床肝胆病杂志, 2021, 37(11): 2737-2741. DOI: 10.3969/j.issn.1001-5256.2021.11.055.
引用本文: 原文聪, 何桥, 王志鑫, 等. 良性胆管狭窄的内镜诊疗现状[J]. 临床肝胆病杂志, 2021, 37(11): 2737-2741. DOI: 10.3969/j.issn.1001-5256.2021.11.055.
YUAN WC, HE Q, WANG ZX, et al. Current status of endoscopic diagnosis and treatment of benign biliary stricture[J]. J Clin Hepatol, 2021, 37(11): 2737-2741. DOI: 10.3969/j.issn.1001-5256.2021.11.055.
Citation: YUAN WC, HE Q, WANG ZX, et al. Current status of endoscopic diagnosis and treatment of benign biliary stricture[J]. J Clin Hepatol, 2021, 37(11): 2737-2741. DOI: 10.3969/j.issn.1001-5256.2021.11.055.

良性胆管狭窄的内镜诊疗现状

DOI: 10.3969/j.issn.1001-5256.2021.11.055
基金项目: 

国家重点研发计划项目 2017YFC0909900;

青海省科技厅项目 2020-ZJ-Y01

详细信息
    通信作者:

    任利,renliweimin_xn@126.com

    原文聪,何桥对本文贡献相同,同为第一作者

  • 中图分类号: R657.46

Current status of endoscopic diagnosis and treatment of benign biliary stricture

Research funding: 

National Key R&D Program Project 2017YFC0909900;

Qinghai Province Science and Technology Department Project 2020-ZJ-Y01

  • 摘要: 良性胆管狭窄(BBS)指由一系列非恶性肿瘤疾病引起的胆管完全性或不完全性狭窄。其病因复杂多样,未充分治疗的BBS甚至会出现严重并发症。目前临床上使用的诊断方法有影像学、内镜逆行胰胆管造影、超声内镜、胆道镜等,治疗上有球囊扩张、支架置入、经皮经肝胆管引流术、手术治疗等措施。目前通过内镜下诊疗BBS成为首选方法, 然而目前BBS尚无明确分型,需进一步探究。通过查阅国内外相关文献资料,重点对BBS内镜下诊断及按分型治疗相关问题作一综述。

     

  • 表  1  各内镜诊断方法操作方式的特点及用途

    操作方式 特点 用途
    导管内超声(intraductal ultrasonography,IDUS) 鉴别MBS与BBS敏感度、特异度、准确度高;联合ERCP对鉴别BBS敏感度及准确度高[21] 鉴别良恶性胆管狭窄[21]
    探头式共聚焦显微内镜(probe based confocal laser endomicroscopy, PCLE) 预测恶性病变敏感度、特异度、准确度均高于ERCP组织活检[22] 评估良恶性胆管狭窄[23]
    光学相干层析成像(optical coherence tomography,OCT) 对ERCP细胞刷检/组织活检有补充作用[24] 为恶性肿瘤的预测提供标准化的标准[24]
    下载: 导出CSV

    表  2  根据狭窄部位和病因选择治疗方式

    狭窄部位 常见病因 内镜治疗
    远端胆总管 慢性胰腺炎 MPS、FCSEMS
    肝外中段胆管(据肝门>1 cm) 肝移植、胆囊切除术 MPS、FCSEMS
    肝门、肝内胆管 PSC、IgG4-SC 球囊扩张、塑料支架(多/单)
    手术胆肠吻合口 Roux-en-Y吻合,肝结肠吻合和Whipple手术后的吻合口狭窄 球囊扩张
    注:MPS,多根塑料支架;FCSEMS,全覆盖自膨胀金属支架;PSC,原发性硬化性胆管炎;IgG4-SC,IgG4相关性硬化性胆管炎。
    下载: 导出CSV
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