ERCP与EUS-FNA融合技术对胰腺癌合并梗阻性黄疸的诊治效能  

The Efficacy of Combined Endoscopic Ultrasound Fine-needle Aspiration and Endoscopic Retrograde Cholangiopancreatography in Same Session for the Diagnosis and Management of Pancreatic Carcinoma with Obstructive Jaundice

作　　者：赵亦周 李佳宁[1] 王强[1] 伍东升[1] 张晟瑜[1] 吴晰[1] 郭涛[1] 蒋青伟[1] 杨莹韵[1] 施文 冯云路[1] 杨爱明[1] ZHAO Yizhou;LI Jianing;WANG Qiang;WU Dongsheng;ZHANG Shengyu;WU Xi;GUO Tao;JIANG Qingwei;YANG Yingyun;SHI Wen;FENG Yunlu;YANG Aiming(Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院消化内科,北京100730

出　　处：《协和医学杂志》2024年第4期819-824,共6页Medical Journal of Peking Union Medical College Hospital

基　　金：国家重点研发计划(2022YFC3602103);中央高水平医院临床科研专项(2022-PUMCH-B-024,2022-PUMCH-A-177)。

摘　　要：目的探讨超声内镜引导下细针穿刺术(endoscopic ultrasound fine-needle aspiration,EUS-FNA)和内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)融合技术在胰腺癌合并梗阻性黄疸患者诊疗中的应用价值。方法回顾性收集2023年1月1日—2024年2月26日北京协和医院消化内科住院接受ERCP胆管支架引流胰腺癌合并梗阻性黄疸患者的临床资料。根据是否在同一内镜单元进行EUS-FNA,将其分为融合技术组和单纯ERCP组。比较两组病理诊断率、ERCP引流成功率、术后并发症发生率及患者单次住院时间差异。结果共入选符合纳入与排除标准的接受ERCP胆管支架引流的胰腺癌合并梗阻性黄疸患者161例,其中融合技术组80例,单纯ERCP组81例。融合技术组病理诊断率高于单纯ERCP组[92.50%(74/80)比46.15%(12/26),P<0.001],ERCP引流成功率[82.50%(66/80)比86.42%(70/81),P=0.360]、术后总并发症发生率[5.00%(4/80)比2.47%(2/81),P=0.443]、单次住院时间[4(4,7)d比5(3,9)d,P=0.397]与单纯ERCP组均无统计学差异。结论EUS-FNA与ERCP融合技术可显著提升胰腺癌合并梗阻性黄疸病理诊断率,且不影响ERCP引流效果,不增加术后并发症率发生率,有助于提高临床诊疗效率。Objective To explore the application value of endoscopic ultrasound fine-needle aspiration(EUS-FNA)and endoscopic retrograde cholangiopancreatography(ERCP)in the diagnosis and treatment of patients with pancreatic cancer combined with obstructive jaundice.Methods Clinical data of patients hospi-talized in the Department of Gastroenterology of Peking Union Medical College Hospital who underwent ERCP biliary stent drainage for pancreatic cancer combined with obstructive jaundice from January 1,2023 to February 26,2024 were retrospectively collected.They were categorized into the fusion technology group and the simple ERCP group according to whether EUS-FNA was performed in the same endoscopic unit.The differ-ences in pathologic diagnosis rate,ERCP drainage success rate,postoperative complication rate and patients'single hospitalization time were compared between the two groups.Results A total of 161 patients with pancre-atic cancer combined with obstructive jaundice who underwent ERCP biliary stent drainage meeting the inclusion and exclusion criteria were enrolled,of which 80 were in the fusion technique group and 81 were in the simple ERCP group.The pathological diagnosis rate in the fusion technique group was higher than that in the simple ERCP group[92.50%(74/80)vs.46.15%(12/26),P<0.001],and the ERCP drainage suc-cess rate[82.50%(66/80)vs.86.42%(70/81),P=0.360],the overall postoperative complication rate[5.00%(4/80)vs.2.47%(2/81),P=0.443],and single hospitalization time[4(4,7)d vs.5(3,9)d,P=0.397]were not statistically different from simple ERCP groups.Conclusion The fusion of EUS-FNA and ERCP enhances the efficiency of diagnosis and treatment for pancreatic carcinoma,warranting wide-spread adoption and further research.

关 键 词：胰腺癌 梗阻性黄疸 超声内镜引导下细针穿刺术 内镜下逆行胰胆管造影术 技术融合 

分 类 号：R61[医药卫生—外科学] R735.9[医药卫生—临床医学]