超声引导下经皮细针穿刺活检诊断胰腺病变

Ultrasound-guided percutaneous fine-needle biopsy in diagnosis of pancreatic lesions

目的探讨超声引导下经皮细针穿刺活检诊断胰腺病变的临床应用价值。方法选取本院胰腺病变患者104例,均于超声引导下用20G自动切割针行经皮穿刺活检。104例患者中16例以手术后病理做最终诊断,88例以活检病理结合影像学检查及随访结果做最终诊断。评价穿刺活检取材满意率,诊断符合率及术后并发症情况。结果 104例患者中胰腺局灶性病变97例(97/104,93.27%),其中实性病变84例(84/97,86.60%),囊实性病变13例(13/97,13.40%),弥漫性病变7例(7/97,6.73%)。104例患者共接受112次穿刺活检,97次取材满意并得到病理诊断,其中实性病变取材满意率(89/97,91.75%)高于囊实性病变(8/15,53.33%),优势比为9.973。97例取材满意标本中得到的病理诊断与最终诊断相符者89例,8例诊断不相符者均误诊为胰腺炎。活检诊断的准确率、敏感度、特异度分别为91.75%(89/97)、90.12%(73/81)、100%(16/16)。患者活检后7例发生并发症,均为轻-中度腹痛,无严重并发症发生。结论超声引导下经皮细针穿刺活检胰腺病变安全、有效,其对胰腺实性病变取材满意率优于囊实性病变。

Objective To investigate the diagnostic value of ultrasound-guided percutaneous fine-needle biopsy for pancreatic lesions.Methods Ultrasound-guided percutaneous biopsy was performed with automated cutting needle in 104 patients with pancreatic lesions.Of the 104 patients,the final diagnosis was made by pathology diagnosis after operation in 16 cases,and the final diagnosis of the other 88 cases were made by the combination of biopsy,imaging studies and follow-up results.The acquisition rate of satisfied specimens,diagnostic accordance rate and postoperative complications were retrospectively analyzed.Results Ninety-seven（97/104,93.27%）cases of 104 patients were pancreatic focal lesion,of which84（84/97,86.60%）cases were solid lesions,13（13/97,13.40%）were cystic-solid lesions;and 7cases（7/97,6.73%）were diffuse lesions.One hundred and twelve biopsies were carried out in 104 patients,and 97 cases obtained pathological diagnosis.The satisfaction rate in the solid lesions was 91.75%（89/97）,which was superior to that in cystic-solid lesions53.33%（8/15）,the odds ratio was 9.973.Of the 97 cases,89cases matched the final diagnosis,and 8cases were misdiagnosed as pancreatitis.The diagnosis accuracy,sensitivity and specificity were 91.75%（89/97）,90.12%（73/81）and100%（16/16）,respectively.Seven patients had a complication of mild to moderate pain,and no serious complications occurred.Conclusion Ultrasound-guided percutaneous fine-needle biopsy of pancreatic lesions can be safe and efficient.The acquisition rate of satisfied specimens in pancreatic solid lesions is higher than that in cystic-solid lesions.