术前超声内镜引导下细针穿刺对可切除胰腺癌诊断之安全性和准确性的探讨

Safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer

目的探讨术前超声内镜引导下细针穿刺(EUS-FNA)对可切除胰腺癌患者诊断之安全性及准确性。方法回顾性分析该院2010年1月-2014年12月256例胰腺癌患者的临床资料,其中82例有手术切除的指征:54例术前行EUS-FNA术(FNA+组)和28例无术前EUS-FNA(FNA-组),观察EUS-FNA的诊断情况及两组患者的生存时间。结果 FNA+组54患者EUS均见肿瘤病灶,所有患者FNA均成功。根据细胞学和组织学,EUS-FNA诊断的准确性分别为94.44%(51/54)和88.89%(48/54),总准确率为94.44%(51/54)。2例EUS-FNA后出现轻度胰腺炎,2例并发出血,经保守治疗后痊愈,无其他严重并发症。在FNA+和FNA-组的中位无复发存活时间分别为282和265 d(P>0.05),平均总生存时间分别为568和557 d(P>0.05)。FNA+组的RFS和OS并不逊色于FNA-组。这些数据表明,EUS-FNA并不影响中位无复发存活期或总生存期,也没有增加其他并发症的风险。结论术前EUS-FNA对可切除胰腺癌患者是一种安全、准确的诊断方法。

Objective To evaluate the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guid- ed fine-needle aspiration in patients with pancreatic cancer. Methods 256 patients with pancreatic cancer from Jan- uary 2010 to December 2014, 82 were considered resectable on the basis of cross-sectional imaging findings. Of these patients, 54 underwent EUS-FNA before surgery （FNA＋ group） and 28 underwent surgery without preoperative EUS-FNA （FNA- group）, the diagnosis result of EUS-FNA and the survival time of the two groups were observed. Results All 54 lesions were visible on EUS, and all 54 attempts at FNA were technically successful. The diagnostic accuracy according to cytology and histology tindings was 94.44 % （51/54） and 88.89 % （48/54）, respectively, and the total accuracy was 94.44 % （51/54）. Two patients developed mild pancreatitis and two hemorrhage after EUS- FNA but were successfully treated by conserwltive therapy. No severe complications occurred after EUS-FNA. In the FNA＋ and FNA- groups, the median relapse--free survival （RFS） was 282 and 265 d, respectively （P 〉 0.05）, and the median overall survival （OS） was 568 and 557 d, respectively （P 〉 0.05）. RFS and OS were therefore not inferior in the FNA＋ group. These data indicate that the usage of EUS-FNA did not influence RFS or OS, nor did it increase the risk of other complications. Conclusions Preoperative EUS-FNA is a safe and accurate diagnostic method.