内镜超声引导下细针穿刺抽吸术对胰腺癌的诊断价值  

Endoscopic ultrasonography-guided fine-needle aspiration in diagnosis of pancreatic cancer

作　　者：邹晓平[1] 张斌[1] 李雯[1] 徐肇敏[1] 

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210008

出　　处：《中华消化内镜杂志》2009年第4期184-187,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜超声引导下细针穿刺抽吸术（EUS-FNA）对胰腺占位性病变特别是胰腺癌的诊断价值。方法对2005年后经B超、CT、MRI等影像学诊断和（或）临床疑诊胰腺癌的37例患者，在EUS引导下对病变作细针穿刺抽吸活检（FNA），对于囊实性病变同时抽取囊液化验淀粉酶及肿瘤标志物等指标。结果EUS-FNA检出胰腺导管细胞癌16例，转移性肾细胞癌1例，可疑癌5例，异型细胞6例，正常胰腺组织6例，非胰腺成分3例。随访至2008年7月时，已证实胰腺癌25例，良性10例（慢性胰腺炎4例，囊腺瘤4例，假性囊肿2例），尚有2例无法确诊。EUS-FNA诊断胰腺癌的敏感性为80．0％（95％CI：59．0-93．0），特异性为100．0％（95％CI：60．0—100．0），阳性预测值为100．0％（95％CI：80．0-100．0），阴性预测值为55．6％（95％CI：27．0-79．0）。6例病变获取囊液进行淀粉酶、肿瘤标志物分析。本组EUS-FNA术后无严重并发症发生。结论EUS-FNA是一项安全有效的操作，对于胰腺占位性病变尤其是胰腺癌的诊断具有重要的意义。Objective To evaluate the diagnostic value of endoscopic uhrasonography-guided fineneedle aspiration （EUS-FNA） for pancreatic occupying lesion, especially pancreatic cancer. Methods From year of 2005, 37 patients with suspected pancreatic cancer by means of ultrasound, CT or MRI received EUS-FNA. Amylase and tumor markers （CEA, CA19-9 and CA125） in cyst fluid were analyzed if applicable. The patients were followed up till July 2008, and the results of EUS-FNA were compared with those confirmed during the follow-up. Results The EUS-FNA yielded diagnosis of 16 cases of pancreatic ductal adenocarcinoma, 1 metastatic renal cancer, 5 suspicious malignancy, 6 atypia, 6 normal pancreatic tissue, and 3 normal non-pancreatic tissue. During the follow-up, 25 cases of pancreatic cancer and 10 benign lesions, including 4 chronic pancreatitis, 4 cyst-adenoma and 2 pseudocyst, were confirmed, and the other 2 cases still remained un-determined. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNA were 80. 0% （95% CI： 59. 0-93.0） , 100. 0% （95% CI： 60. 0-100. 0） , 100. 0% （95% CI： 80. 0-100. 0）, and 55.6% （95% CI： 27.0-79. 0）, respectively. No severe procedurerelated complication was observed. Conclusion EUS-FNA is a safe and effective modality for diagnosis of pancreatic occupying lesions, especially panereatic cancer.

关 键 词：内窥镜超声检查 针吸活组织检查 细针 胰腺癌 

分 类 号：R735[医药卫生—肿瘤] R44[医药卫生—临床医学]