内镜超声引导细针穿刺对胰腺癌的诊断价值  

The diagnosis on pancreatic lesions with endoscopic ultrasound guided fine-needle aspiration

作　　者：杨秀疆[1] 谢渭芬[1] 任大宾[1] 刘苏[1] 陈伟忠[1] 胡志前[1] 蔡洪培[1] 

机构地区：[1]第二军医大学长征医院消化科,上海200003

出　　处：《中华消化杂志》2005年第8期462-465,共4页Chinese Journal of Digestion

摘　　要：目的了解内镜超声(EUS)引导细针穿刺(FNA)对胰腺癌的临床价值及安全性。方法选择临床诊断或临床及影像学疑诊胰腺癌患者共21例,男13例,女8例,平均年龄(59.8±15.3)岁。EUS发现病变后,在实时超声引导下用超声穿刺针行FNA,对3例无法手术的胰腺癌患者行FNA同时,以无水乙醇阻滞腹腔神经丛治疗癌痛。结果B超共检出胰腺占位16例(16/21),未检出的5例中3例经CT检出,CT共检出胰腺占位19例;EUS检出全部21例胰腺占位,5例位于胰体尾,16例位于胰头。18例患者EUS-FNA获满意标本,17例诊断为胰腺癌,1例诊断为慢性胰腺炎,胰腺癌诊断敏感性为85.0%、特异性为100.0%、准确度为85.7%。3例行无水乙醇阻滞后疼痛减轻。术后发生轻度胰腺炎1例、发热1例。结论EUS能有效检出胰腺占位,结合FNA可提高诊断的特异性及准确性。Objective Endoscopic ultrasound （EUS） guided fine-needle aspiration （FNA） of pancreatic lesions is being increasingly used. The aim of the study was to evaluate its safety, accuracy, and clinical utility in the diagnosis of paneareatic diseases. Methods EUS-guided FNA was performed in 91 patients （13 men and 8 women） with pancreatic lesions （16 head/neck, 5 body/ tail） detected by CT seanining, unltrasonography or clinically suspected diagnosis. Three patients with unresectable pancreatic cancer underwent EUS-guided celiac plexus neurolysis（CPN） for pain-relieving. Results The lesions detected by CT scanning （19 cases） and ultrasonography（16 cases） were all confirmed by EUS. Adequate specimens were obtained by EUS-guided FNA in 18 of 21 lesions and final diagnosis in these sub jects was pathologically confirmed. EUS-guided FNA had a sensitivity of 85.0%. specificity of 100.0% and accuracy of 85.7% for diagnosis of pancreatic lesions. The final diagnosis was not obtained in three patients due to inadequate specimens. Three patients with pancreatic carcinoma were decreased in pain scores after EU%CPN. Two cases with complication of mild pancreatitis or post FNA fever were found. Conclusions EUS-guided FNA of the pancreas was a safe and effective modality for diagnosis and treatment of pancreatic lesions.

关 键 词：内镜超声 细针穿刺 胰腺癌 胰腺炎 

分 类 号：R735.9[医药卫生—肿瘤] R730.41[医药卫生—临床医学]