谐波造影增强超声内镜在诊断胰腺癌中的作用

The role of contrast-enhanced harmonic endoscopic ultrasonography in the diagnosis of pancreatic cancer

目的探讨谐波造影增强超声内镜（CH—EUS）在诊断胰腺癌中的作用。方法选择胰腺占位病变患者为研究对象，以超声内镜引导下细针穿刺（EUS-FNA）或组织病理学及随访结果作为最终诊断，与CH．EUS诊断比较，评价CH—EUS诊断胰腺癌的准确度，并分析CH—EUS在不同胰腺肿瘤中的图像特点。结果共76例患者入选，平均年龄（53．1±14．2）岁，其中胰腺癌35例，局灶肿块型炎症21例，胰腺神经内分泌肿瘤10例，囊腺瘤6例，胰管内乳头状产黏蛋白肿瘤4例。肿瘤最大直径平均（3．4±1．4）cm，〈2cm者18例。CH—EUS诊断胰腺癌的灵敏度97．1％，特异度92．9％，阳性预测值91．7％，阴性预测值97．5％。行EUS．FNA64例，CH-EUS联合FNA对胰腺癌检查的灵敏度达到100％。结论CH—EUS可安全、简便、准确地显示胰腺病变的血供情况，对于胰腺癌诊断的敏感度、特异度均较高，是EUS—FNA的有力补充，值得临床推广应用。

Objective To evaluate the diagnostic accuracy of contrast-enhanced harmonic EUS （CH-EUS） for pancreatic cancer. Methods Patients with pancreatic occupying lesion underwent CH-EUS with ultrasonic contrast medium Sonovue. Pathological diagnoses by EUS-FNA or surgery and the follow-up results were made as the final diagnosis to evaluate the accuracy of CH-EUS for pancreatic cancer. Characteristics of CH-EUS in different pancreatic tumors were analysed. Results A total of 76 patients were enrolled, with an average age of 53.1 ± 14. 2. Thirty-five were finally diagnosed as having pancreatic cancer, 21 local mass-type pancreatitis, 10 pancreatic neuroendocrine tumor, 6 cystadenoma, 4 intraductal papillary mucinous neoplasm. Tumor diameter was 3.4 ± 1.4 cm and there were 18 less than 2 era. The sensitivity and specificity, positive and negative predictive value of CH-EUS for pancreatic cancer was 97. l%, 92. 9% , 91.7% and 97.5% respectively. The sensitivity was 100% combined with FNA. Conclusion CH-EUS is safe, convenient for pancreatic cancer with high accuracy and can be used as an additional diagnostic method to EUS-FNA.