影像学和快速病理学检查对胰腺囊性肿瘤诊治价值的临床研究  

Clinical study of imaging and rapid pathology in diagnosis and treatment of pancreatic cystic neoplasm

作　　者：龚新利 程坤[1] 林海[1] 孙永辉 陈启龙[1] GONG Xinli;CHENG Kun;LIN Hai;SUN Yonghui;CHEN Qilong(Department of Pancreatic Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi,830011,P.R.China;Department of Hepatobiliary,Pancreatic,and Spleen Surgery,Tongchuan People’s Hospital,Tongchuan,Shaanxi 727000,P.R.China)

机构地区：[1]新疆医科大学第一附属医院胰腺外科,乌鲁木齐830011 [2]铜川市人民医院肝胆胰脾外科,陕西铜川727000

出　　处：《中国普外基础与临床杂志》2019年第12期1409-1416,共8页Chinese Journal of Bases and Clinics In General Surgery

基　　金：新疆维吾尔自治区自然科学基金（项目编号：2016D01C328)

摘　　要：目的探讨术前影像学及术中快速病理对胰腺囊性肿瘤(pancreatic cystic neoplasm,PCN)诊治的指导价值。方法回顾性分析2003年7月14日至2018年7月31日期间在新疆医科大学第一附属医院治疗并经病理诊断为PCN的205例患者的临床资料,比较其术前影像学和术中快速病理结果与术后常规病理诊断的差异性,并分析术前影像学及术中快速病理对PCN的精确+模糊诊断率及错误诊断率。结果205例患者中,术前最常用的影像学方法为超声和CT检查,分别为146例(82.95%)和141例(80.11%),MRI检查较少,为54例(30.68%);47例行单项检查,行联合检查共129例,其中超声联合CT检查最常见,为123例(95.35%)。超声、CT及MRI检查对PCN的精确+模糊诊断率分别为81.51%(119/146)、81.56%(115/141)和87.04%(47/54)。超声与CT及MRI检查相比较精确+模糊诊断率较低(χ2=47.747,P<0.001;χ2=11.873,P=0.018),而CT与MRI检查比较差异无统计学意义(χ2=5.012,P>0.05)。超声错误诊断的27例中,未发现明显异常14例(51.85%),其次为误诊为胰腺假性囊肿11例(40.74%);CT错误诊断的26例中,误诊为胰腺癌最多,15例(57.69%);MRI错误诊断的7例中,误诊为胰腺癌及胰腺假性囊肿各3例(42.86%)。术中快速病理错误诊断的31例中,误诊为胰腺假性囊肿最多,10例(32.26%);其次为SPN误诊为胰腺神经内分泌肿瘤7例(22.58%)。术前影像学、术中快速病理及术前影像学联合术中快速病理对PCN的精确+模糊诊断率分别为81.58%(124/152)、86.84%(132/152)及97.37%(148/152);而错误诊断率分别为18.42%(28/152)、13.16%(20/152)及2.63%(4/152)。结论术前影像学及术中快速病理检查中,超声有不能发现PCN病变的可能;CT和MRI检查最易误诊为胰腺癌;术中快速病理检查误诊为胰腺假性囊肿最多见。完善术前影像学及联合术中快速病理可提高PCN的正确诊断率,从而避免不合理的外科干预措施。Objective To investigate the guiding value of preoperative imaging and intraoperative rapid pathology in the diagnosis and treatment of pancreatic cystic neoplasm(PCN).Methods The clinical data of 205 patients with PCN diagnosed by pathology from July 14,2003 to July 31,2018 were analyzed retrospectively.The precise and fuzzy diagnostic rate and misdiagnosis rate of PCN by preoperative imaging and intraoperative rapid pathology were analyzed.Results The most commonly used preoperative imaging methods were ultrasound and CT,in 146 cases(82.95%)and 141 cases(80.11%),respectively.There were 54 cases(30.68%)with MRI.Of them,47 cases were examined by single examination,129 cases received combined examination,of which 123 cases(95.35%)were examined by ultrasound combined with CT.The precise and fuzzy diagnostic rate of PCN by ultrasound,CT,and MRI were 81.51%(119/146),81.56%(115/141),and 87.04%(47/54),respectively.Comparison of ultrasound with CT and MRI showed statistical significance(χ2=47.747,P<0.001;χ2=11.873,P=0.018),but no significant difference was observed between CT and MRI(χ2=5.012,P>0.05).In 27 cases of false diagnosis by ultrasound,no obvious abnormality was found in 14 cases(51.85%),followed by misdiagnosis as pancreatic pseudocyst(11 cases,40.74%).Of the 26 cases misdiagnosed as pancreatic cancer by CT,57.69%(15 cases)were misdiagnosed as pancreatic cancer;7 cases were misdiagnosed by MRI,42.86%(3 cases)of patients were misdiagnosed as pancreatic cancer and pancreatic pseudocyst.Thirty-one cases were misdiagnosed by intraoperative rapid pathology,and most of them misdiagnosed as pancreatic pseudocyst(10 cases,32.26%).The next was SPN misdiagnosed as pancreatic neuroendocrine tumor(7 cases,22.58%).The precise and fuzzy diagnostic rates of PCN were 81.58%(124/152),86.84%(132/152),and 97.37%(148/152)in preoperative imaging,intraoperative rapid pathology,and preoperative imaging combined with intraoperative rapid pathology,while the misdiagnostic rates were 18.42%(28/152),13.16%(20/152),and 2.63%(4/152),re

关 键 词：胰腺囊性肿瘤 诊断 术前影像学检查 术中快速病理检查 

分 类 号：R73[医药卫生—肿瘤]