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

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

原文聪^{1, 2},
何桥^{1, 2},
王志鑫^{1, 2},
樊海宁^{1, 2},
王海久^{1, 2},
任宾^{1, 2},
任利^{1, 2, ,}

1.
青海大学附属医院肝胆胰外科，西宁 810001
2.
青海省包虫病研究重点实验室，西宁 810001

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
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- 被引次数: 0
出版历程
- 收稿日期: 2021-03-31
- 录用日期: 2021-04-12
- 出版日期: 2021-11-20

Current status of endoscopic diagnosis and treatment of benign biliary stricture

Wencong YUAN^{1, 2},
Qiao HE^{1, 2},
Zhixin WANG^{1, 2},
Haining FAN^{1, 2},
Haijiu WANG^{1, 2},
Bin REN^{1, 2},
Li REN^{1, 2
, ,}

1.
Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, Xining 810001, China
2.
Qinghai Province Key Laboratory of Hydatid Disease Research, Qinghai 810001, China

Research funding:

National Key R&D Program Project (2017YFC0909900);

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

摘要

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。
- 胆管疾病 /
- 内窥镜检查 /
- 超声检查 /
- 诊断 /
- 治疗学
Abstract: Benign biliary stricture (BBS) refers to complete or incomplete stricture of the biliary tract caused by a series of non-malignant diseases. BBS often has complex and diverse etiologies, and severe complications may occur if it is not adequately treated. Diagnostic methods currently used in clinical practice include imaging, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, and choledochoscopy, and treatment methods include balloon dilatation, stent implantation, percutaneous transhepatic biliary drainage, and surgical treatment. At present, endoscopic diagnosis and treatment of BBS has become the preferred method. However, there is still no clear classification of BBS, which needs further investigation. By consulting related literature in China and globally, this article summarizes the issues associated with the endoscopic diagnosis and treatment of BBS.
- Bile Duct Diseases /
- Endoscopy /
- Ultrasonography /
- Diagnosis /
- Therapeutics

HTML全文

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]

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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。

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