影像引导下经皮胰腺占位性病变穿刺活检临床实践

Clinical practice of image-guided percutaneous core biopsy for pancreatic masses

目的:探讨CT或B超图像引导下经皮胰腺占位性病变穿刺活检的临床应用价值。方法:194例经B超或核磁共振/CT检查发现胰腺占位的患者接受CT或B超影像引导下经皮胰腺占位性病变穿刺活检。对取得的组织标本进行病理学检查。结果:CT引导下穿刺90例,平均穿刺次数为2.8次;B超引导下穿刺104例,平均每例穿刺2.3次。总的穿刺活检诊断准确率为97.9%(190/194)。病理诊断为胰腺恶性病变172例(90.5%),其中导管腺癌160例、囊腺癌和黏液腺癌各4例、恶性间质瘤和非霍奇金淋巴瘤各2例;良性病变18例(9.5%,18/190),其中浆液腺瘤4例、黏液腺瘤和结核各2例、慢性炎性疾病和假性囊肿各5例。术后,40例(20.6%)患者出现上腹痛(中度10例,轻度30例),160例(82.5%)患者出现过性血淀粉酶升高;未发生其他严重并发症。结论:CT或B超图像引导下经皮胰腺占位性病变穿刺活检是种准确率较高的临床诊断方法,定位精确且安全性较高。

Objective： To evaluate the clinical value of CT or type-B ultrasound image-guided percutaneous core biopsy for diagnosis of pancreatic masses. Methods： A total of 194 cases found with pancreatic lesions by type-B ultrasound, CT or magnetic resonance imaging （MRI） underwent CT or ultrasound image-guided percutaneous core biopsy. The tissue samples were examined histologically. Results： Of 194 cases, 90 underwent CT image-guided biopsy with an average of 2.8 passes and 104 underwent type-B ultrasound image-guided biopsy with an average of 2.3 passes. The overall accuracy of diagnosis was 97.9% （190/194）. There were 172 cases （90.5%） of malignant lesions, including ductal adenocarcinoma in 160 cases, cystadenocarcinoma in 4 cases, mucinous adenocarcinoma in 4 cases, malignant stromal tumor in 2 cases, and non-Hodgkin＇s lymphoma in 2 cases. Meanwhile, there were 18 cases （9.5%） of benign lesions, including serous cystadenoma in 4 cases, mucinous cystadenoma in 2 cases, tuberculosis in 2 cases, chronic pancreatitis in 5 cases and pancreatic pseudocyst in 5 cases. After biopsy, 20.6% （40/194） of the cases complained of abdominal pain （10 were moderate, 30 were mild） and 82.5% （160/194） of the cases had a transient elevation of serum amylase. No severe complications occured. Conclusion： CT or type-B ultrasound image-guided percutaneous core biopsy for diagnosis of pancreatic masses is a convenient and safe method with a high positioning and diagnostic accuracy.