超声内镜引导细针穿刺诊断肝尾状叶肿瘤4例

Endoscopic ultrasoundguided fine needle aspiration of hepatic caudate lobe malignancy:Report of 4 cases

目的:复习肝脏尾状叶肿瘤的病例资料,评价内镜超声引导下细针穿刺(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)肝尾状叶对恶性肿瘤的诊断价值.方法:4例患者其他影像学检查发现肝脏占位,并行相应的辅助检查.总结其主要临床特点.肝脏尾状叶占位和相关部位行EUS-FNA,穿刺物行细胞学检查和组织学检查.内镜超声在食管胃连接处探头指向右侧扫查到肝尾状叶,穿刺肝尾状叶.结果:4例患者,男3例,女1例,年龄50岁-69岁.穿刺9个部位(肝尾状叶4,肝左叶1,胰腺2,肝门淋巴结1,腹膜后淋巴结1).9个穿刺部位中,肝门部淋巴结未获得足够的组织学标本,仅作细胞学涂片诊断腺癌转移;其他8个病灶均获得足够的组织学标本进行细胞学涂片和组织学检查,均获得明确的病理学诊断和临床诊断.所有患者均未出现并发症.诊断胰头癌并肝转移2例,胆管细胞癌并肝门淋巴结转移1例,原发性肝癌并腹腔转移1例.结论:内镜超声在食管胃连接处探头指向右侧可非常容易扫查到肝尾状叶,行EUS-FNA路径短,可精准穿刺到肝尾状叶的占位,安全性高,EUS-FNA肝尾状叶肿瘤有重要的临床价值.

AIM： To investigate the diagnostic value of en- doscopic ultrasound-guided fine needle aspira- tion （EUS-FNA） in the detection of hepatic cau- date lobe masses. METHODS： Clinical data for four patients with hepatic malignancy （three males and one female, aged 50 to 69 years） were retrospectively ana- lyzed. The diagnostic accuracy of EUS-FNA was assessed by cell smear and histological examination. All patients were closely monitored for complications after EUS-FNA. RESULTS： Nine solid lesions were aspirated （4 in the caudate lobe, 1 in the left lobe, 2 in the pancreatic head, 1 in the hilar lymph node, and 1 in the retroperitoneal lymph node）. All aspirates （9/9） were available for cell smear and 88.9% （8/9） for histological analysis. The diagnosis rates of cell smear and HE staining were 100% （9/9） and 100% （8/8）, respectively. All 4 patients were diagnosed with hepatic malignancy （2 cases of primary liver cancer and 2 cases of liver metastasis from pancreatic cancer）. No obvious complications were observed in all patients. CONCLUSION： Given the relationship between hepatic caudate lobe and the cardia in topo- graphic anatomy, EUS allows for easily scan- ning enlarged porta hepatis and retroperitoneal lymph nodes simultaneously and guiding FNA. EUS and EUS-FNA have important clinical value in the diagnosis of hepatic caudate lobe tumors.