超声内镜引导下细针抽吸活检术在胰腺占位性病变中的应用

Clinical application of endoscopic ultrasound guided fine needle aspiration biopsy in pancreatic space-occupying lesions

目的探讨超声内镜引导下细针抽吸活检术(EUS-FNA)在胰腺占位性病变中的临床应用特点。方法选择2018年1月~2022年1月于本院因可疑胰腺占位性病变行EUS-FNA检查的55例患者作为研究对象,患者年龄62.91±11.21岁,其中男性29例、女性26例。以穿刺样本的组织学病理结果为金标准,分析行EUS-FNA检查患者的一般临床资料及其病变特点、胰管情况、穿刺次数及术后并发症等。评价EUS-FNA诊断胰腺占位性病变的敏感度、特异性、准确度,以及影响准确性的临床因素。结果55例患者均成功进行EUS-FNA,穿刺成功率100%,所有患者获得穿刺病理。术后不良反应2例,其中1例为腹痛,1例为高淀粉酶血症,经临床常规处理后均恢复良好。经EUS-FNA诊断明确的有48例(87.27%),诊断未明确的有7例(12.73%),诊断敏感度为92.31%(48/52),特异性为100%(3/3),准确度为92.73%(51/55),阳性预测值为100%(48/48),阴性预测值为42.86%(3/7);EUS-FNA的准确性与患者年龄、胰管扩张情况有关(P<0.05),与性别、血糖、肿瘤标记物、病灶性状、病变大小、部位、穿刺针数、细胞学检查方法等无关(P>0.05)。结论EUS-FNA对胰腺占位性病变诊断的敏感度、特异性、准确度均很高,并发症少见且轻微,为临床提供了有效的诊断方法。

Objective To investigate the clinical application of endoscopic ultrasonography guided fine needle aspiration(EUSFNA)biopsy in pancreatic space occupying lesions.Methods Fifty-five patients who underwent EUS-FNA examination for suspected pancreatic space-occupying lesions in the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2022 were screened,with an average age of 62.91±11.21 years,including 29 males and 26 females.The general clinical data,lesion characteristics,pancreatic duct conditions,puncture times and postoperative complications of patients undergoing EUS-FNA were analyzed,with the histopathological results of puncture samples as the gold standard.We evaluated the sensitivity,specificity,and accuracy of EUS-FNA in diagnosing pancreatic space-occupying lesions,as well as the clinical factors affecting the accuracy.Results EUS-FNA was successfully performed in all these 55 patients,the puncture success rate was 100%,and puncture pathology was obtained in all patients.Postoperative adverse reactions occurred in 2 cases,including abdominal pain in 1 case and hyperamylasemia in 1 case.All patients recovered well after routine clinical treatment.Fortyeight cases(87.27%)were definitely diagnosed by EUS-FNA,and 7 cases(12.73%)were not definitely diagnosed.The diagnostic sensitivity was 92.31%(48/52),specificity was 100%(3/3),accuracy was 92.73%(51/55),positive predictive value was 100%(48/48),negative predictive value was 42.86%(3/7).The accuracy of EUS-FNA was related to the patient's age and pancreatic duct dilatation(P<0.05),but not gender,blood glucose,tumor markers,lesion characteristics,lesion size,location,times of puncture needles,cytological examination methods(P>0.05).Conclusion EUS-FNA has high sensitivity,specificity and accuracy in the diagnosis of pancreatic space occupying lesions.The complications are rare and mild,which provides an effective diagnostic method for clinical practice.