初步探讨新型国产经口胆道镜在胆管内乳头状肿瘤(IPNB)诊断中的临床价值。

回顾性分析2020年1月至2025年12月经南京中医药大学附属医院江苏省中医院消化内镜中心(11例)及南京大学医学院附属鼓楼医院(1例)接受国产经口胆道镜检查并诊断为IPNB的12例患者的临床资料。所有患者均经腹部影像学检查(CT/MRI)提示胆管扩张或占位性病变，进一步行内镜下逆行胰胆管造影术(ERCP)＋国产经口胆道镜检查，记录镜下表现、活检病理诊断结果及并发症情况。

12例患者中，男5例、女7例，年龄55~84岁，平均(67.9±8.9)岁。主要临床表现为右上腹痛7例、右上腹痛伴发热4例、黄疸1例。影像学检查均提示肝内(和/或)外胆管扩张，其中6例可见胆管内充盈缺损或软组织影。国产经口胆道镜下表现：鱼卵状4例、乳头状5例，水草状2例，伴黏液分泌8例，病变位于肝门部胆管5例、左肝管2例、右肝管1例、肝门部＋左肝管1例、胆总管上段和下段各1例，病变部位不详1例。共10例患者行内镜下活检，病理诊断为IPNB伴癌变2例、IPNB伴高级别瘤变2例、IPNB伴低级别瘤变3例、IPNB 1例、黏膜慢性炎2例、未取活检病理2例。ERCP＋胆道镜术后无并发严重并发症，2例出现高淀粉酶血症、1例胆道感染，术后48 h均恢复正常。

国产经口胆道镜可直接观察胆管内病变形态，结合活检病理能精准诊断IPNB，且安全性良好，具有重要的临床应用价值。

To explore the clinical application value of a novel domestic peroral cholangioscopy in the diagnosis of intraductal papillary neoplasms of the bile duct (IPNB).

A retrospective analysis was performed on the clinical data of 12 patients diagnosed with intraductal papillary neoplasm of the bile duct (IPNB) who underwent domestic peroral cholangioscopy between January 2020 and December 2025, including 11 patients from the Digestive Endoscopy Center of Jiangsu Provincial Hospital of Chinese Medicine and 1 patient from Nanjing Drum Tower Hospital..Abdominal imaging examinations (CT/MRI) revealed biliary duct dilation or space-occupying lesions in all patients. All patients further received ERCP combined with domestic peroral cholangioscopy.Endoscopic manifestations, biopsy pathological results and complications were recorded.

Among the 12 patients, there were 5 males and 7 females, aged 55 to 84 years old with an average age of (67.9±8.9) years.The main clinical manifestations included right upper abdominal pain (7 cases), right upper abdominal pain complicated with fever (4 cases), jaundice (1 case).Imaging examinations all indicated intrahepatic and/or extrahepatic bile duct dilation, among which filling defects or soft tissue shadows in the bile duct were observed in 6 cases. The morphological findings under peroral cholangioscopy were fish-egg-like lesions (4 cases), papillary lesions (5 cases) and waterweed-like lesions (2 cases), with mucus secretion identified in 8 patients.Lesions were located in hilar bile duct (5 cases), left hepatic duct (2 cases), right hepatic duct (1 case), hilar combined with left hepatic duct (1 case), upper segment and lower segment of common bile duct (1 case each), and the lesion site was unclear in 1 case.Endoscopic biopsy was performed in 10 patients.Pathological diagnoses included IPNB with carcinogenesis (2 cases), IPNB with high-grade intraepithelial neoplasia (2 cases), IPNB with low-grade intraepithelial neoplasia (3 cases), simple IPNB (1 case), chronic mucosal inflammation (2 cases), and no biopsy was conducted in 2 cases.No severe complications occurred after cholangioscopy.Two patients developed hyperamylasemia and one patient suffered from biliary tract infection, all of whom recovered within 48 hours.

Domestic peroral cholangioscopy can directly observe the morphological characteristics of intraductal biliary lesions, and can achieve accurate diagnosis of IPNB combined with biopsy pathology. It features favorable safety and possesses important clinical application value.