内镜超声引导下细针型共聚焦显微内镜检查在胰腺肿瘤诊断中的初步应用

The application of endoscopic ultrasound-guided needle-based confocal laser endomicroscopy in diagnosis of pancreatic neoplasms

目的初步探讨内镜超声引导下细针型共聚焦显微内镜（EUS—nCLE）在胰腺肿瘤诊断中的应用。方法临床诊断为胰腺占位性病变的患者，在EUS引导下用19G穿刺针穿刺后，置入共聚焦微探头，根据获取的图像判断病变性质，并与病理对照，评估EUS．nCLE的诊断价值及并发症发生率。结果28例患者成功行EUS—nCLE检查，均获得质量良好的图像。最终诊断浆液性囊腺瘤5例、黏液性囊腺瘤3例、导管内乳头状黏液肿瘤3例、假性囊肿1例、导管腺癌10例、神经内分泌肿瘤1例、实性假乳头肿瘤2例、慢性胰腺炎2例、淋巴瘤1例。在26例有病理诊断的患者中，nCLE诊断符合率为73．1％（19／26），其中浆液性囊腺瘤和导管内乳头状黏液肿瘤的特异度达100％（7／7）。EUS—nCLE相关并发症发生率为10．7％（3／28），主要为胰腺炎和囊内出血。结论EUS—nCLE在胰腺肿瘤诊断中是安全可行的，诊断浆液性囊腺瘤和导管内乳头状黏液肿瘤的特异度较高。

Objective To discuss the application of endoscopic ultrasound-guided needle-based eonfocal laser endomieroscopy （EUS-nCLE） in the diagnosis of pancreatic neoplasms. Methods Patients with pancreatic neoplasms were diagnosed by endoscopic ultrasonography and punctured by 19 G needle, and then the confoeal microprobe was implanted through the needle. The lesions nature was estimated according to obtained images. The diagnostic yield and complication was evaluated and compared with pathology. Results A total of 28 patients successfully underwent EUS-nCLE, and high quality images were obtained in all patients. The final diagnosis were 5 cases of serous cystadenoma （SCN）, 3 cases of mueinous eystadenoma, 3 cases of intraduetal papillary mueinous neoplasms （IPMN） , 1 case of pseudocyst, 10 cases of ductal adenocarcinoma, 1 case of neuroendocrine tumor, 2 cases of solid pseudopapillary tumor, 2 cases of chronic pancreatitis, and 1 cases of lymphoma. The diagnostic yield in 26 patients with pathology was 73.1% （19/26） and the specificity of SCN and IPMN was 100% （7/7）. The complications, mostly pancreatitis and intracystie hemorrhage, occurred in 10. 7% （3/28） patients. Conclusion EUS-nCLE is a safe and feasible method in the diagnosis of pancreatic neoplasms, and shows high specificity in SCN and IPMN.