超声内镜对胰腺癌早期诊断价值的评估

The early diagnostic value of endoscopic ultrasonography for pancreatic carcinoma

目的评估超声内镜对胰腺癌早期诊断的价值。方法2007年1月-2007年6月经手术病理确诊为胰腺癌的患者126例,明确诊断前半月内均接受过超声(US)、超声内镜(EUS)及螺旋CT(SCT)检查,术后证实为小胰腺癌(癌块直径≤2cm)28例,癌块直径>2cm者98例。比较术前接受US、SCT和EUS检查的影像学异常发现率、诊断准确率及间接征象准确率等,探讨超声内镜对胰腺癌早期诊断的价值。结果联合应用EUS及SCT检查,胰腺癌异常影像的发现率、诊断准确率大为提高,与单独应用US、EUS或SCT相比,有显著性差异(P<0.05);以术后病理报告为标准,在评估胰周组织浸润、血管侵犯等间接征象方面EUS与SCT无显著性差异(P>0.05);对小胰腺癌的诊断,EUS诊断准确率显著高于US和SCT(P<0.05)。结论EUS在胰腺癌早期诊断中有重要价值,EUS联合SCT能提高胰腺癌的早期检出率。

Objective To assess the early diagnostic value of endoscopic ultrasonography （EUS） for the patients with pancreatic carcinoma. Methods One hundred and twenty-six patients were finally diagnosed as pancreatic carcinoma by pathological examination in the institute of gastroenterology, Changhai Hospital of the Second Military Medical University. All patients had been given ultrasonography （US）, EUS and spiral CT urography （SCT） examinations half a month before operation. Postoperative reports showed that 28 eases were small pancreatic adenocarcinoma （diarneter≤2cm） and 98 cases were adenocarcinoma （diameter〉2cm）. A retrospective analysis was performed to compare such indexes before and after operation as radiological unusual discovery rate, diagnostic accuracy and indirect signs （abnormal ultrasonography of biliary systems, main pancreatic duct stricture, encroached organs, blood vessels and lymph nodes）, unusual rate of US, SCT and EUS for evaluating the early diagnostic value of US for pancreatic carcinoma. Results Combined application of EUS and SCT improved both radiological unusual discovery rate and diagnostic accuracy, which showed significant difference compared with those applied with US, EUS and SCF alone （P〈0. 05）. There was not significant difference between EUS and SCT for assessment of tumor indirect signs such as peri-pancreatic tissues and vascular involved in carcinoma （ P〉0. 05）. The diagnostic accuracy of EUS to small pancreatic adenocarcinoma was remarkably higher than that of US and SCT （P〈0. 05）. Conclusions EUS possesses important early diagnostic value for the patients with pancreatic carcinoma. EUS combined with SCT can significantly improve the early screening rate of pan creatlc carcinoma.