超声内镜引导下细针穿刺活检(EUS-FNA)在胰腺占位性病变中的诊断价值及安全性评估

The diagnostic value and safety of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) in pancreatic lesions

目的探讨超声内镜引导下细针穿刺术(EUS-FNA)对胰腺占位性疾病的诊断价值和安全性。方法回顾性分析我科2011年1月至2015年10月对92例胰腺占位患者行EUS-FNA检查的病史资料,结合术后并发症、开腹探查结果及术后的病理结果,评估EUS-FNA对胰腺占位性病变术前诊断率、相关血管侵犯准确性、手术可切除性和安全性。结果全部患者均成功完成EUS-FNA操作,仅1例出现贲门黏膜轻度撕裂出血,保守治疗痊愈,无胆瘘、消化道穿孔、胰腺炎等严重并发症出现,成功获得病变组织条86例(93.5%),获得病理诊断69例(80.2%),无法诊断为17例(19.8%),肿瘤小于2cm和临床诊断为非肿瘤病例是无法获得病理诊断的两个重要因素,超声探测20例肿块与血管侧壁侵犯,准确率为83.3%(20 vs 24例),预计不可切除8例,准确性达100%。结论 EUS-FNA在进行胰腺占位病变的术前诊断是安全可行的,但诊断率偏低,对判断肿块与血管侵犯情况和可切除性上有较高的参考价值。

Objective To investigate the diagnostic value and safety of endoscopic ultrasound-guided fine needle aspiration （EUS-FNA） in pancreatic lesions. Methods The clinical data of 92 patients received EUS-FNA examination from January 2011 to October 2015 at the department of general surgery in Provincial Hospital Affiliated to Anhui Medical University was retrospectively analyzed. The preoperative diagnosis rate, the accuracy of related vascular invasion, surgical resection and safety of EUS-FNA were evaluated by the combination of postoperative complications, laparotomy results and postoperative pathological results. Results All these 92 patients with pancreatic lesions were detected by EUS, only 1 case had mild bleeding of gastric cardiac mucosa, cured by conservative treatment, and there are no serious complications such as biliary fistula, perforation of digestive tract and pancreatitis occurred in the other cases. However, We~,e only got 86 cases of lesion tissue strip（93.5% ）, of which 69 patients （80. 2% ） were diagnosed with pathological diagnosis, and 17 patients （ 19. 8% ） were not diagnosed. There are two important factors that cause the inability to get pathological diagnosis,include： 1. The tumor＇s diameter is less than 2 cm; 2. The cases were diagnosed as non neoplastic lesions. We found that 20 cases （83.3%） invaded the vascular wall and 8 cases （ 100% ） can＇ t be resected by ultrasound which were proved as 24 cases and 8 cases in the middle of surger. Conclusion EUS-FNA is safe and feasible in the preoperative diagnosis of pancreatic space-occupying lesions, but the diagnosis rate is low, and it has a certain reference value for judging the tumor and vascular invasion and the removal of the tumor.