内镜超声引导下细针穿刺抽吸术在诊断上消化道及其周围占位病变中的价值  

Endoscopic ultrasonography guided fine needle aspiration for diagnosis of occupying lesions in upper digestive tract and its peripheral areas

作　　者：彭海霞[1] 杨大明[1] 褚以忞[1] 蒯榕[1] 李吉[1] 陶琨[2] 金云菲[1] 王赛玉[1] 

机构地区：[1]上海交通大学医学院附属同仁医院内窥镜室,上海200336 [2]上海交通大学医学院附属同仁医院病理科,上海200336

出　　处：《临床军医杂志》2015年第7期680-683,共4页Clinical Journal of Medical Officers

基　　金：上海市卫生和计划生育委员会科研课题(201440426);上海市消化内科重点专科(ZK2012A05)

摘　　要：目的探讨内镜超声引导下细针穿刺抽吸术(EUS-FNA)对上消化道及其周围实质性占位病变诊断的准确性及其临床应用价值。方法回顾性分析2011年11月至2014年5月行超声内镜检查及超声内镜引导下的细针穿刺检查的87例患者的临床资料,对比细胞学和(或)病理学检查与术后病理结果及随访结果。结果本组86例患者成功进行了EUS-FNA,穿刺成功率98.85%。其中,病灶位于食管9例(10.35%),胃39例(44.83%),十二指肠球部10例(11.49%),胰腺18例(20.69%),腹腔10例(11.49%)。74例患者细胞学检查结果为阳性,阳性率85.06%。39例患者获得组织碎片或组织细条行病理学检查,组织获得率44.83%;其中,20例病理学检查结果为阳性,阳性率51.28%。与术后病理结果及术后随访结果对照,EUS-FNA对上消化道及其周围占位病变诊断的准确率为89.65%。对于病灶直径大小(>3 cm及≤3 cm)、穿刺针针号(19G及22G)及抽吸负压(5 ml负压及10 ml负压),两两比较发现,EUS-FNA诊断准确率差异均无统计学意义(P>0.05)。穿刺过程中无明显并发症发生。结论在上消化道及周围实质性占位病变中,EUSFNA是一项安全、有效、准确的诊断及鉴别诊断方法,穿刺诊断的准确性与病灶的大小,穿刺针的针号及穿刺抽吸负压大小无明显相关性。Objective To evaluate the accuracy and clinical application of endoscopic ultrasound guided fine needle aspiration （EUS-FNA） in diagnosis of occupying lesions in upper digestive tract and its peripheral areas. Methods Forty-six patients under- went endoscopic ultrasonagraphy and EUS-FNA between November 2011 and May 2014. The resuh of cytology and/or pathology was compared with that of surgical finding and follow-up study. Results EUS-FNA was successfully performed on 86 patients, with a success rate of 98.85 %. In all 86 patients, lesions were located in oesophagus （ 9 cases）, stomach （ 39 cases）, duodenalbulb （ 10 ea- ses）,pancreas（ 18 cases）, and abdomen （10 cases）. Among them, the lesions in 74 patients （85.06%）were cytologically con- firmed. The lesions in 20 out of 39 patients （51.28%） were pathologically confirmed Compared with the results of pathology and long-term followe-up study, the overall diagnostic accuracy of EUS-FNA in diagnosis of lesions in upper digestive tract and its pe- ripheral areas was 89.65 %. There was no significant difference between the loci larger and smaller than 3 cm （ P 〉 0.05 ） , similar between 22-gauge and 19-gauge needles（ P 〉0.05 ）and also similar between 5 ml negative pressure suction and 10 ml（ P 〉 0.05 ）. There were no complications during the procedures. Conclusion EUS-FNA is a safe, effective and accurate method for diagnosis of occupying lesions in upper digestive tract and its peripheral areas. Moreover, the diagnosis accuracy is not about the size of lesions, the size of needles and the intension of negative pressure suction.

关 键 词：内窥镜超声检查 活组织检查 细针穿刺抽吸术 

分 类 号：R472[医药卫生—护理学]