胰腺实性占位超声内镜引导下细针抽吸术后空气冲刷法与重新插入针芯法的取材效果  

The comparative study on the effect of the air flushing and the reinsertion of the needle core after the ultrasonography-guided fine-needle aspiration in solid pancreatic mass

作　　者：刘惠芳[1] 沈浩[1] 简捷[1] 胡友文 章诺贝[1] LIU Huifang;SHEN Hao;JIAN Jie;HU Youwen;ZHANG Nuobei(Department of Gastroenterology,the Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi,330000,China)

机构地区：[1]南昌大学第二附属医院消化内科,江西南昌330000

出　　处：《当代医学》2024年第22期164-168,共5页Contemporary Medicine

摘　　要：目的比较胰腺实性占位超声内镜引导下细针抽吸术(EUS-FNA)后评估空气冲刷法与重新插入针芯法的取材效果。方法回顾性分析2021年1—12月在南昌大学第二附属医院因胰腺实性占位行EUS-FNA的116例患者的临床资料。患者均使用22G FNA针行EUSFNA,通过重新插入针芯或分别缓慢注入5、10、20 ml空气进行取材。根据EUS-FNA实施后取材方法的不同,分为重新插入针芯组(n=35)、5 ml空气冲刷组(n=22)、10 ml空气冲刷组(n=39)与20 ml空气冲刷组(n=20)。EUS-FNA诊断基于细胞学检查,最终诊断基于细胞学诊断、手术病理学和临床或影像学随访的综合标准。通过细胞量和血液污染评价细胞学标本质量。比较4组细胞学诊断能力效能和样本质量。结果4组准确度、灵敏度、阳性预测值、阴性预测值、血液污染评分≥2分占比比较差异有统计学意义(P<0.05)。10 ml空气冲刷组诊断准确度和灵敏度均高于重新插入针芯组、5 ml空气冲刷组和20 ml空气冲刷组,阳性预测值高于重新插入针芯组,血液污染评分≥2分占比低于5 ml空气冲刷组、20 ml空气冲刷组和重新插入针芯组,差异有统计学意义(P<0.05)。结论在EUS-FNA中使用22G FNA针对胰腺实性占位进行穿刺后,10 ml空气冲刷可增加细胞学诊断的准确度和灵敏度,仅伴有轻微的血液污染。Objective To compare the effect of the air flushing and the reinsertion of the needle core after the ultrasonography-guided fine-needle aspiration(EUS-FNA)in solid pancreatic mass.Methods The clinical data of 116 patients who underwent EUS-FNA due to solid pancreatic space in the Second Affiliated Hospital of Nanchang University from January to December 2021 were retrospectively analyzed.EUS-FNA was performed with 22G FNA needle,and samples were obtained by re-inserting the needle core or slowly injecting 5,10,and 20 ml of air,respectively,they were divided into the re-insertion group(n=35),5 ml air flushing group(n=22),10 ml air flushing group(n=39),and the 20 ml air flushing group(n=20)according to different sampling methods after the implementation of EUS-FNA.The diagnosis of EUS-FNA is based on cytological examination,and the final diagnosis is based on a combination of cytological diagnosis,surgical pathology,and clinical or imaging follow-up.The quality of cytological specimens was evaluated by cell volume and blood contamination.The cytological diagnostic ability efficiency and sample quality among the four groups were compared.Results There were significant differences in accuracy,sensitivity,positive predictive value,negative predictive value and blood contamination score≥2 scores among the four groups(P<0.05).The diagnostic accuracy and sensitivity in the 10 ml air flushing group were higher than those in the re-insertion group,the 5 ml air flushing group and the 20 ml air flushing group,the positive predictive value was higher than that in the re-insertion group,the proportion of blood contamination score≥2 scores was lower than that in the 5 ml air flushing group,the 20 ml air flushing group and the re-insertion group,the differences were statistically significant(P<0.05).Conclusion After puncture of solid pancreatic mass with 22G FNA in EUS-FNA,10 ml air flushing can increase the accuracy and sensitivity of cytological diagnosis,and only accompanied by slight blood contamination.

关 键 词：超声内镜引导下细针抽吸术 胰腺实性占位 空气冲刷法 重新插入针芯法 准确度 灵敏度 血液污染 

分 类 号：R73[医药卫生—肿瘤]