超声内镜引导下细针穿刺术在实性成分为主的胰腺肿瘤中的诊断价值  

Diagnostic value of endoscopic ultrasonography-guided fine needle aspiration in mostly solid pancreatic cancer

作　　者：魏珏[1] 李彬彬[2] 蒋计生[2] 曾欣[1] 谢渭芬[1] 

机构地区：[1]上海长征医院消化内科,上海200003 [2]上海长征医院病理科,上海200003

出　　处：《上海医学》2017年第12期731-735,共5页Shanghai Medical Journal

基　　金：国家自然科学基金资助(81400611)

摘　　要：目的探讨超声内镜引导下细针穿刺术(EUS-FNA)在以实性成分为主的胰腺肿瘤中的诊断价值。方法回顾性分析2015年1月—2017年7月在上海长征医院行EUS-FNA的50例胰腺肿瘤患者的临床资料。所有胰腺肿瘤均获EUS-FNA或外科手术后病理确诊。分析其临床特征、超声内镜(EUS)特点、病理特征,评价EUS-FNA的诊断价值。结果 EUS可以清晰地显示胰腺肿瘤的部位、回声、大小、形态、边界和淋巴结转移、胰周血管侵犯等情况。EUS-FNA平均每人穿刺1.64针,无并发症发生。50例患者中,EUS-FNA联合细胞学涂片、液基薄层细胞检测(TCT)和组织病理学检查的阳性率分别为87.8%、50.0%和96.0%,三者联合可将EUS-FNA的阳性率提高至98%。结论 EUS可以精准地显示肿瘤局部浸润、淋巴结转移和胰周血管侵犯情况,EUS-FNA联合细胞学涂片、TCT和组织病理学检查对以实性成分为主的胰腺肿瘤的病理诊断价值较大。Objective To evaluate the diagnostic value of endoscopic ultrasound-guided fine needle aspiration （EUS-FNA） in mostly solid pancreatic masses. Methods We retrospectively reviewed 50 patients who underwent EUS-FNA in Shanghai Changzheng Hospital between January 2015 and July 2017. All lesions were pathologically diagnosed by EUS-FNA and/or surgery. Then we summarized the clinical characteristics, endoscopic ultrasound （EUS） and pathological features of the pancreatic cancer, and evaluated the diagnostic value of EUS- FNA. Results EUS clearly demonstrated the location, echo, size, morphology, border, regional lymphatic metastasis and vascular involvement of the pancreatic carcinoma. The average frequency of EUS-FNA was 1.64 times in all the cases, and no complications occurred. The positive diagnosis rates of cytological smear, fluid based thin-layer cytological test （TCT） and histopathology examination by EUS-FNA were 87.8%, 50.0% and 96.0%, respectively. The positive rate of EUS-FNA could be increased to 98% by combination of the three methods. Conclusion EUS can clearly demonstrate the local invasion, regional lymphatic metastasis and peripancreatic vascular invasion. EUS-FNA can contribute greatly to the pathological diagnosis of pancreatic cancer if it is used with cytological smear TOT and histopathology examination together.

关 键 词：胰腺癌 超声内镜引导下细针穿刺 超声内镜 诊断 

分 类 号：R735.9[医药卫生—肿瘤]