超声内镜引导下细针抽吸活检术在胰腺占位性病变中的应用

杨冬媛; 周军伟; 汪强武; 柯希权; 王启之; 燕善军; 郑海伦

doi:10.12122/j.issn.1674-4500.2023.02.06

超声内镜引导下细针抽吸活检术在胰腺占位性病变中的应用

doi: 10.12122/j.issn.1674-4500.2023.02.06

蚌埠医学院第一附属医院消化科，安徽蚌埠 233004

基金项目:

蚌埠医学院512人才培育计划项目 by51201216

安徽省自然科学基金资助项目 1808085MH240

详细信息

作者简介:
杨冬媛，在读硕士研究生，E-mail: renaissancegrace@163.com

通讯作者:
郑海伦，主任医师，副教授，硕士生导师，E-mail: alanhailun@163.com

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出版历程
- 收稿日期: 2022-10-20
- 网络出版日期: 2023-04-28
- 刊出日期: 2023-03-20

Clinical application of endoscopic ultrasound guided fine needle aspiration biopsy in pancreatic space-occupying lesions

Department of Gastroenterology, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China

摘要

摘要: 目的探讨超声内镜引导下细针抽吸活检术（EUS-FNA）在胰腺占位性病变中的临床应用特点。方法选择2018年1月~2022年1月于本院因可疑胰腺占位性病变行EUS-FNA检查的55例患者作为研究对象，患者年龄62.91±11.21岁，其中男性29例、女性26例。以穿刺样本的组织学病理结果为金标准，分析行EUS-FNA检查患者的一般临床资料及其病变特点、胰管情况、穿刺次数及术后并发症等。评价EUS-FNA诊断胰腺占位性病变的敏感度、特异性、准确度，以及影响准确性的临床因素。结果 55例患者均成功进行EUS-FNA，穿刺成功率100%，所有患者获得穿刺病理。术后不良反应2例，其中1例为腹痛，1例为高淀粉酶血症，经临床常规处理后均恢复良好。经EUS-FNA诊断明确的有48例（87.27%），诊断未明确的有7例（12.73%），诊断敏感度为92.31%（48/52），特异性为100%（3/3），准确度为92.73%（51/55），阳性预测值为100%（48/48），阴性预测值为42.86%（3/7）；EUS-FNA的准确性与患者年龄、胰管扩张情况有关（P < 0.05），与性别、血糖、肿瘤标记物、病灶性状、病变大小、部位、穿刺针数、细胞学检查方法等无关（P > 0.05）。结论 EUS-FNA对胰腺占位性病变诊断的敏感度、特异性、准确度均很高，并发症少见且轻微，为临床提供了有效的诊断方法。
- 胰腺占位性病变 /
- 超声内镜引导下细针抽吸活检术 /
- 病理学检查
Abstract: Objective To investigate the clinical application of endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) biopsy in pancreatic space occupying lesions. Methods Fifty-five patients who underwent EUS-FNA examination for suspected pancreatic space-occupying lesions in the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2022 were screened, with an average age of 62.91±11.21 years, including 29 males and 26 females. The general clinical data, lesion characteristics, pancreatic duct conditions, puncture times and postoperative complications of patients undergoing EUS-FNA were analyzed, with the histopathological results of puncture samples as the gold standard. We evaluated the sensitivity, specificity, and accuracy of EUS-FNA in diagnosing pancreatic space-occupying lesions, as well as the clinical factors affecting the accuracy. Results EUS-FNA was successfully performed in all these 55 patients, the puncture success rate was 100%, and puncture pathology was obtained in all patients. Postoperative adverse reactions occurred in 2 cases, including abdominal pain in 1 case and hyperamylasemia in 1 case. All patients recovered well after routine clinical treatment. Forty-eight cases (87.27%) were definitely diagnosed by EUS-FNA, and 7 cases (12.73%) were not definitely diagnosed. The diagnostic sensitivity was 92.31% (48/52), specificity was 100% (3/3), accuracy was 92.73% (51/55), positive predictive value was 100% (48/48), negative predictive value was 42.86% (3/7). The accuracy of EUS-FNA was related to the patient's age and pancreatic duct dilatation (P < 0.05), but not gender, blood glucose, tumor markers, lesion characteristics, lesion size, location, times of puncture needles, cytological examination methods (P > 0.05). Conclusion EUS-FNA has high sensitivity, specificity and accuracy in the diagnosis of pancreatic space occupying lesions. The complications are rare and mild, which provides an effective diagnostic method for clinical practice.
- pancreatic space-occupying lesions /
- endoscopic ultrasonography guided fine needle aspiration /
- pathological examination

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图 1 细胞学检查结果效能比较

Figure 1. Comparison of efficacy of cytological examination results.

下载: 全尺寸图片幻灯片

图 2 胰头占位性病变EUS-FNA图像

A: 可见胰腺头部见不均匀低回声病变, 边界欠清, 病灶最大截面约20.8 mm×25.5 mm, 如红色箭头所示; B: 胰腺头部病变EUS彩色多普勒显示见少许血流信号，如蓝色箭头所示; C: EUS彩色多普勒观察病变及穿刺点周围血流情况, 如红色箭头所示; D: 选择胰头穿刺点后, 在彩色多普勒引导下确定穿刺深度, 用COOK 22 G穿刺针穿刺胰腺低回声病变, 蓝色箭头所示为穿刺针.

Figure 2. EUS-FNA image of pancreatic head occupying lesion

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表 1 EUS-FNA对胰腺占位性病变的诊断影响因素分析

Table 1. Analysis of factors affecting the diagnosis of pancreatic space-occupying lesions by EUS-FNA

影响因素	EUS-FNA		P
影响因素	诊断明确（n=48）	诊断未明确（n=7）	P
年龄（岁, Mean±SD）	64.58±10.14	51.43±12.26	0.003
性别[n(%)]			0.335
男	27(93.10)	2(6.90)
女	21(80.77)	5(19.23)
血糖（mmol/L）	5.93（5.13~7.34）	6.24（4.89~7.10）	0.820
肿瘤标记物
CA19-9（U/mL）	61.00（5.85~228.18）	20.60（15.91~82.21）	0.762
CEA（ng/mL）	3.43（2.06~8.14）	2.81（2.56~4.07）	0.860
AFP（ng/mL）	3.05（2.40~5.36）	2.38（1.60~3.18）	0.245
CA153（U/mL）	7.15（5.01~10.68）	8.60（6.20~14.10）	0.216
病灶性状[n(%)]			0.266
实性	40(90.91)	4(9.09)
囊实性	8(72.73)	3(27.27)
病变部位[n(%)]			0.246
胰头	29(82.86)	6(17.14)
胰体	12(92.31)	1(7.69)
胰尾	7(100.00)	0(0)
胰管情况[n(%)]			0.019
扩张	42(93.33)	3(6.67)
不扩张	6(60.00)	4(40.00)
病灶最大直径[cm, n(%)]			0.421
≤2	10(76.92)	3(23.08)
> 2	38(90.48)	4(9.52)
穿刺针数[n(%)]			0.796
≤2次	21(84.00)	4(16.00)
≥3次	27(90.00)	3(10.00)

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表 2 EUS-FNA穿刺诊断结果及最终诊断结果

Table 2. EUS-FNA puncture diagnosis results and final diagnosis results

诊断结果	EUS-FNA结果（n）		最终诊断例数（n）	构成比（%）
诊断结果	诊断明确	诊断未明确	最终诊断例数（n）	构成比（%）
胰腺囊实性占位	9	2	11	20.00
囊腺瘤	6	1	7	12.73
导管内乳头状粘液瘤	2	1	3	5.45
浆液性囊腺瘤	1	0	1	1.82
胰腺实性占位	39	2	41	74.55
胰腺癌	33	1	34	61.82
炎性病变	4	0	4	7.27
神经内分泌肿瘤	2	1	3	5.45
未明确的病变	0	3	3	5.45
合计	48	7	55	100.00

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