陈康海 龚高全 钱朱萍 周建伟 石建国 葛婷

[摘要] 目的 探讨恶性梗阻性黄疸经PTCD路径获取病理诊断的临床应用价值。方法 2017年1月—2019年3月回顾性分析36例经PTCD路径活检的恶性梗阻性黄疸患者病历资料，36例患者均接受PTCD治疗，引流术后2周或计划植入支架之前经PTCD路径行钳夹或毛刷活检。结果 36例中30例获得活检病理诊断，28例获得阳性病理诊断。36例患者中，2例患者出现胆心反射，予阿托品对症治疗好转，余患者术中术后未出现严重并发症。其中3位患者总胆红素下降后行外科手术，活检与术后病理诊断一致。结论 恶性梗阻性黄疸经PTCD路径活检获取病理诊断是安全、微创、有效、便捷及较高的阳性率。

[关键词] 恶性;梗阻性黄疸;PTCD;活检

[Abstract] Objective To explore the clinical application value of pathological diagnosis of malignant obstructive jaundice via PTCD pathway. Methods From January 2017 to March 2019， the history of 36 patients with malignant obstructive jaundice who underwent PTCD biopsy was retrospectively analyzed. All 36 patients were treated with PTCD. Two weeks after drainage， or before stent implantation was planned with Forceps or brush biopsy. Results Among 36 cases， 30 cases obtained pathological diagnosis of biopsy and 28 cases obtained positive pathological diagnosis. Of the 36 patients， 2 patients had biliary reflexes， and symptomatic treatment with atropine improved. The remaining patients did not have serious complications during and after the operation. Three patients underwent surgery after total bilirubin decreased， and biopsy was consistent with postoperative pathological diagnosis. Conclusion The pathological diagnosis of malignant obstructive jaundice via PTCD pathway biopsy is safe， minimally invasive， effective， convenient and has a high positive rate.

[Key words] Malignant; Obstructive jaundice; PTCD; Biopsy

西医黄疸是多种疾病的共同症状和体征，它不是一个独立的疾病;目前根据血清增高的胆红素性质，黄疸分为非结合胆红素和结合胆红素血症;结合胆红素占血清总胆红素的30%以上，根据发病机制可分为肝细胞性、胆汁淤积性或遗传性因素所引起的黄疸;其中胆汁淤积性疾病又分为梗阻性和非梗阻性，其中梗阻性膽汁淤积常见，肝内梗阻性胆汁淤积常见病因有肝内胆管泥沙样结石、原发性肝癌侵犯胆管或形成肿瘤栓子及华支睾吸虫等;其中肝外梗阻性常见病因有胆石症、胆道蛔虫、癌肿浸润、手术后胆管狭窄或壶腹部周围癌、胰头癌、肝癌、肝门或胆总管周围淋巴结癌肿转移而受压。目前梗阻性黄疸发病具有隐匿……