内镜超声引导下细针穿刺活检术对影像学拟诊肝脏恶性肿瘤的诊断价值  

Endoscopic ultrasoud-guided fine-needle aspiration biopsy for hepatic mass suspicious of malignancy

作　　者：童旭东[1] 丁祥武[1] 邱丽[1] 李峥[1] 杨雨[1] 古丽芳[1] 高山[1] 梁晋军[2] 聂世贵[2] 

机构地区：[1]湖北省襄阳市中心医院湖北文理学院附属医院消化内科,441021 [2]湖北省襄阳市中心医院湖北文理学院附属医院病理科,441021

出　　处：《中华消化内镜杂志》2013年第8期429-432,共4页Chinese Journal of Digestive Endoscopy

基　　金：2011～2012年度湖北省卫生厅青年人才项目（QJX-2010-57）

摘　　要：目的评价内镜超声引导下细针穿刺活检术（EUS—FNA）在影像学拟诊为肝脏恶性肿瘤患者中的临床应用价值。方法回顾29例经影像学拟诊为肝脏恶性肿瘤行EUS—FNA检查患者的临床资料，总结细胞学、组织学、病理学诊断结果以及随访并发症发生情况。结果29例共穿刺29处肝脏占位（尾状叶8处、左叶19处、右叶深部2处），穿刺32处非肝脏占位（胰腺9处、胆囊2处、胃壁1处、肺1处、右肾上腺1处、淋巴结18处）。61处（100．0％）均能行细胞学检查，56处（91．8％，56／61）能行组织学检查，48处（78．7％，48／61）能行免疫组化检查。病理学诊断为原发性肝癌8例，其中1例肝脏病灶细胞学和组织学均无阳性发现，经同时肝门淋巴结细胞学明确诊断，其余7例（87．5％，7／8）肝脏病灶细胞学和组织学均为阳性；病理学诊断为转移性肝癌2l例，肝脏病灶细胞学、组织学和病理学阳性率分别为76．2％（16／21）、85．7％（18／21）和100．0％（21／21），所有病变部位（包括肝脏、原发病灶和肿大淋巴结）的病理学阳性率达98．0％（48／49）。所有患者未发生明显的并发症。结论基于深部肝脏与贲门、胃和十二指肠的局部解剖关系，EUS—FNA对于肝脏尾状叶、左叶和右叶深部的恶性肿瘤有肯定的诊断价值，是经皮肝脏穿刺活检的重要补充，应受到临床重视。Objective To investigate the diagnostic value of endoscopic ultrasound-gnided fine needle aspiration （EUS-FNA） biopsy in hepatic mass suspicious of malignancy. Methods This study retrospectively analyzed the clinical data of 29 patients （17 males and 12 females） with suspected hepatic malig- nancy aged from 30 to 80 years （ mean 57 -＋ 9. 7 years）. The yield of EUS-FNA were assessed by cell smear and histological examination. All patients were under close observation for complications after EUS-FNA. Results A total of 29 hepatic lesions （8 in caudate lobe, 19 in left lobe, and 2 in right lobe） and 32 extra- hepatic lesions （9 in pancreas, 2 in gallbladder, 1 in stomach, 1 in lung, 1 in right adrenal gland and 18 lymph nodes ） were fine-needle aspirated. All samples （61/61） were suitable for cell smear, 91.8% （56/61） for hematoxylin-eosin staining and 78.7% （48/61） for immunohistochemistry. In 29 patients, 8 were diagnosed as primary hepatic cancer （6 hepatocellular cancer, 2 cholangiocellular cancer）, and 21 were diagnosed as metastatic hepatic malignancy with 9 from pancreatic cancer, 3 from gallbladder cancer, 2 from lung cancer, 1 from gastric stromal tumor, 1 from gastric cancer, 3 from colorectal cancer and 2 from cancer with un-identified origin. No procedure related complications were observed in 29 patients. Conclusion Given the relationship between hepatic caudate lobe and cardia, left lobe and proximal stomach, deep right lobe and duodemum in topographic anatomy, and that EUS can easily scan enlarged mediastinal and retroperitoneal lymph nodes simuhaneously and guide FNA, EUS and EUS-FNA should be weighted in clinical practice.

关 键 词：活组织检查 细针 腔内超声检查 肝肿瘤 病理学 诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学]