内镜超声引导下细针抽吸术对肝外胆管占位的诊断价值

Diagnostic value of endoscopic ultrasound-guided fine needle aspiration for extrahepatic bile duct lesions

目的探讨内镜超声引导下细针抽吸术（EUS-FNA）对肝外胆管占位病变的诊断价值。方法回顾性分析2012年1月至2016年12月在成都市第三人民医院接受EUS-FNA的11例肝外胆管占位患者临床资料，对比其病理学检查结果与术后病理及随访结果。结果11例患者EUS-FNA均获得满意病理学标本。病灶位于近端胆管1例、远端胆管6例、壶腹部4例。EUS-FNA病理学诊断腺癌7例，发现异型细胞且怀疑恶性者1例，发现异型细胞而癌不能除外者1例，良性病变2例；与术后病理及随访结果对比，EUS-FNA对肝外胆管占位诊断的敏感度为89%（8/9），特异度100%（2/2），准确率91%（10/11），阳性预测值100%（8/8），阴性预测值67%（2/3）。术后1例出现轻症胰腺炎，无其他严重并发症。结论EUS-FNA诊断肝外胆管占位安全、可行、有效，具有较好的临床应用价值。

ObjectiveTo assess the value of endoscopic ultrasound-guided fine needle aspiration （EUS-FNA） for diagnosis of extrahepatic bile duct lesions.MethodsA retrospective analysis was performed on the data of 11 patients with extrahepatic bile duct lesions undergoing EUS-FNA in the Third People′s Hospital of Chengdu between January 2012 and December 2016. The result of biopsy was compared with that of surgical finding and follow-up study.ResultsEUS-FNA was successfully performed on 11 patients with 1 lesions in proximal bile duct, 6 in distal bile duct, and 4 in ampulla. According to the results of biopsy, 7 lesions were pathologically confirmed as adenocarcinoma, 1 was suspicious of adenocarcinoma, 1 couldn′t be excluded as carcinoma, and 2 were considered to be benign. Compared with the results of surgical pathology and follow-up study, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of EUS-FNA in diagnosis of extrahepatic bile duct lesions were 89%（8/9）, 100%（2/2）, 91%（10/11）, 100%（8/8）, and 67%（2/3）, respectively. One case suffered mild pancreatitis after EUS-FNA without other complications.ConclusionEUS-FNA is a safe, feasible and effective method for diagnosis of lesions in extrahepatic bile duct.