超声引导下经皮细针穿刺抽吸及穿刺活检诊断胰腺占位性病变

Ultrasound-guided percutaneous fine needle aspiration and core needle biopsy for diagnosing pancreatic space occupying lesions

目的观察超声引导下经皮细针穿刺抽吸(FNA)及穿刺活检(CNB)诊断胰腺占位性病变的价值。方法回顾性分析112例接受超声引导下FNA和/或CNB的胰腺占位性病变患者、共114组穿刺病理,根据穿刺方式将其分为FNA组(n=53)及CNB组(n=61)。以手术病理或临床随访为金标准,对比组间患者一般资料、穿刺及诊断效能差异,分析影响穿刺并发症发生的因素,评价FNA及CNB的价值。结果114组病理中,113组(99.12%,113/114)取材满意;FNA组取材满意率为98.11%(52/53),CNB组为100%(61/61)。穿刺过程中38例出现轻、中度疼痛、1例一过性晕厥,未见严重并发症。FNA组并发症及疼痛发生率均低于CNB组(P均<0.05),FNA诊断胰腺占位性病变的准确率和敏感度亦低于CNB(P均<0.05)。logistic回归分析显示,年龄和穿刺方式是并发症的独立影响因素。结论超声引导下经皮FNA及CNB均可安全有效地诊断胰腺占位性病变;CNB诊断准确率及敏感度较高,而FNA并发症率较低。

Objective To observe the value of ultrasound-guided percutaneous fine needle aspiration(FNA)and core needle biopsy(CNB)for diagnosing pancreatic space occupying lesions.Methods Data of 112 patients with pancreatic space occupying lesions who underwent ultrasound-guided percutaneous FNA and/or CNB were retrospectively analyzed.Totally 114 groups of puncture pathologies were obtained,53 with FNA(FNA group)and 61 with CNB(CNB group).Taken operation pathology or clinical following-up results as standards,patients'general data,puncture and diagnostic efficacy were compared between groups,and the impact factors of the occurrence of puncture complications were observed,and the diagnostic value of FNA and CNB were analyzed.Results Among 114 groups of puncture pathology,113 groups(99.12%,113/114)were sampling satisfactory,and the satisfaction rate of FNA group was 98.11%(52/53),of CNB group was 100%(61/61).Mild or moderate pain were observed in 38 cases,transient syncope occurred in 1 case,but no serious complication occurred.The incidence of complications and pain in FNA group were all lower than that in CNB group(all P<0.05).The accuracy and sensitivity of FNA for diagnosing pancreatic space occupying lesions were lower than those of CNB(both P<0.05).Logistic regression analysis showed that age and puncture methods were independent impact factors of complications.Conclusion Ultrasound-guided percutaneous FNA and CNB were both safe and effective for diagnosing pancreatic space occupying lesions.CNB had higher diagnostic accuracy and sensitivity,while FNA caused less complications.