术中细针穿刺细胞学检查在胰腺病变诊断中的价值  

Value of intraoperative fine needle aspiration cytology in the diagnosis of pancreatic cancer.

作　　者：车旭[1] 张智慧[2] 田艳涛[1] 张建伟[1] 陈应泰[1] 王成锋[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院腹部外科,100021 [2]中国医学科学院北京协和医学院肿瘤医院细胞学室

出　　处：《中华肿瘤杂志》2015年第5期371-374,共4页Chinese Journal of Oncology

摘　　要：目的探讨术中细针穿刺细胞学（IFNAC）检查在胰腺病变诊断中的价值。方法回顾性分析1998年5月至2013年6月间收治的491例胰腺病变患者，总结行IFNAC检查患者的临床特点、IFNAC检查结果、术后病理结果和IFNAC检查的相关并发症等。对影响穿刺准确的因素采用Logisitic回归分析，进行多因素分析。结果491例胰腺病变患者均进行IFNAC检查，其中发现癌细胞（IFNAC阳性）434例，未发现癌细胞（IFNAC阴性）57例。有310例胰腺病变患者获得手术切除，术后病理证实为胰腺导管腺癌209例，胰腺囊腺癌8例，胰腺实性假乳头状肿瘤23例，胰腺神经内分泌肿瘤15例，胰腺导管内乳头状黏液肿瘤14例，原发胰腺的胃肠道间质瘤2例，胰腺浆液性囊腺瘤17例，慢性肿块型胰腺炎22例。IFNAC检查的敏感度为97．9％（425／434），特异度为89．5％（51／57）。IFNAC检查相关并发症为胰瘘，共12例，经治疗后均痊愈，无出血等并发症。多因素Logistic分析显示，肿瘤大小、囊性变、淋巴结转移和合并慢性胰腺炎是影响胰腺癌IFNAC检查的独立因素。结论IFNAC检查具有很高的敏感度和特异度，可作为胰腺癌诊断的有力工具，且临床使用安全。对细胞学阴性的患者，不能单独依靠细胞学结果做出排除诊断，可通过反复取材、结合术中冰冻病理的方法提高准确性。Objective To evaluate the value of intraoperative fine needle aspiration cytology （IFNAC） examination in the diagnosis of pancreatic lesions. Methods The clinicopathological data of 491 patients with pancreatic lesions treated in our hospital from May 1998 to June 2013 were retrospectively analyzed. Their clinical features, IFNAC findings, pathological results after IFNAC examination and related complications were summarized. The factors affecting the aspiration biopsy accuracy were analyzed using logistic regression and multi factor analysis. Results 491 patients with pancreatic lesions were examined by IFNAC. Among them, cancer cells were found in 434 cases （positive） , and were not found in 57 cases （negative）. Among the 310 cases who underwent surgical operation, postoperative pathology confirmed 209 cases of pancreatic ductal adenocarcinoma, 8 cases of pancreatic cystadenocarcinoma, 23 cases of solid pseudopapillary tumor of the pancreas, 15 cases of pancreatic neuroendocrine tumor, 14 cases of intraductal papillary mutinous tumor, 2 cases of primary pancreatic gastrointestinal stromal tumor, 17 cases of pancreatic serous cystadenoma, and 22 cases of chronic mass-forming type pancreatitis. The IFNAC test showed a sensitivity of 97.9% （425/434） , and specificity of 89.5% （51/57）. The IFNAC examination- related complications were pancreatic leakage in a total of 12 patients which were cured after treatment. No bleeding complication was observed. Logistic multivariate analysis showed that tumor size, cystic degeneration, lymph node metastasis and associated chronic pancreatitis are independent factors affecting the IFNAC examination of pancreatic carcinoma. Conclusions IFNAC examination has a high sensitivity and specificity, and with a good safety in clinical use. IFNAC can be used as a powerful tool for the diagnosis of pancreatic cancer, with a high clinical value in use. In the cytology-negative cases, cytology alone can not rule out the diagnosis of pancreatic cancer. Through repeated s

关 键 词：胰腺肿瘤 诊断 细胞学技术 外科手术 

分 类 号：R735.9[医药卫生—肿瘤]