超声内镜引导细针穿刺抽吸术在胰腺占位中应用的安全性分析  

Safety of endoscopic ultrasound-guided fine-needle aspiration for pancreatic lesions

作　　者：陈柯 蔡继东 刘渊 姜子廷 杨秀疆 刘建强 Chen Ke;Cai Jidong;Liu Yuan;Jiang Ziting;Yang Xiujiang;Liu Jianqiang(Department of Endoscopy,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College of Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院内镜科、复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中华消化内镜杂志》2024年第6期459-464,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨超声内镜引导细针穿刺抽吸术(endoscopic ultrasound-guided fine-needle aspiration,EUS-FNA)在胰腺占位性病变中应用的安全性及其风险因素。方法选择2012年1月至2022年12月于复旦大学附属肿瘤医院内镜科行EUS-FNA的5160例患者作为回顾性研究对象,计算操作相关并发症的发生率,利用单因素和logistic回归分析并发症发生的独立风险指标。结果术后胰腺炎发生率为1.38%(68/4930),术中出血发生率为0.82%(42/5143),术后出血发生率为0.78%(40/5143),无直接相关的消化道穿孔和死亡事件发生。年龄>60岁(OR=0.581,95%CI:0.356~0.946,P=0.029)、颈体尾部肿瘤(OR=0.355,95%CI:0.194~0.652,P=0.001)、病灶长径>20~40 mm(OR=0.450,95%CI:0.227~0.893,P=0.023)和病灶长径>40 mm(OR=0.382,95%CI:0.168~0.869,P=0.022)为术后胰腺炎发生的独立保护因素,经十二指肠穿刺(OR=2.435,95%CI:1.319~4.496,P=0.005)是术后胰腺炎独立危险因素。穿刺3~4次(OR=0.439,95%CI:0.235~0.821,P=0.010)、病灶长径>20~40 mm(OR=0.154,95%CI:0.069~0.341,P<0.001)、病灶长径>40 mm(OR=0.326,95%CI:0.143~0.743,P=0.008)是术中出血的独立保护因素。细针穿刺活检(fine-needle biopsy,FNB)针(OR=2.314,95%CI:1.189~4.502,P=0.014)为术后出血的独立危险因素。结论EUS-FNA是一项安全的操作,总体并发症发生率低。术后胰腺炎和术中出血的发生主要与病变临床特征有关,而术后出血与穿刺针类型有关。Objective To investigate the safety and risk factors of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)for pancreatic lesions.Methods Five thousand one hundred and sixty patients who underwent EUS-FNA in the Department of Endoscopy,Fudan University Shanghai Cancer Center from January 2012 to December 2022 were retrospectively reviewed.The incidence of adverse events was calculated,and independent risk factors were analyzed by univariate and logistic regression.Results The incidences of postoperative pancreatitis,intraoperative bleeding and postoperative bleeding were 1.38%(68/4930),0.82%(42/5143)and 0.78%(40/5143)respectively.No perforation or death occurred.Age>60 years(OR=0.581,95%CI:0.356-0.946,P=0.029),tumor located in the neck,body and tail(OR=0.355,95%CI:0.194-0.652,P=0.001),lesion diameter of>20-40 mm(OR=0.450,95%CI:0.227-0.893,P=0.023),and lesion diameter>40 mm(OR=0.382,95%CI:0.168-0.869,P=0.022)were independent protective factors for postoperative pancreatitis.Transduodenal puncture(OR=2.435,95%CI:1.319-4.496,P=0.005)was an independent risk factor for postoperative pancreatitis.Puncture for 3-4 pass(OR=0.439,95%CI:0.235-0.821,P=0.010),lesion diameter of>20-40 mm(OR=0.154,95%CI:0.069-0.341,P<0.001),and lesion diameter>40 mm(OR=0.326,95%CI:0.143-0.743,P=0.008)were independent protective factors for intraoperative bleeding.Fine-needle biopsy(FNB)needle(OR=2.314,95%CI:1.189-4.502,P=0.014)was an independent risk factor for postoperative bleeding.Conclusion EUS-FNA is a safe procedure with low incidence of adverse events.The occurrence of postoperative pancreatitis and intraoperative bleeding is mainly related to clinical characteristics of the lesion,while postoperative bleeding is related to the type of puncture needle.

关 键 词：活组织检查 细针 超声内镜 胰腺炎 出血 并发症 

分 类 号：R657.5[医药卫生—外科学]