目的探讨超声内镜引导下细针穿刺术(EUS-FNA)对胰腺占位性疾病的诊断价值和安全性。方法回顾性分析我科2011年1月至2015年10月对92例胰腺占位患者行EUS-FNA检查的病史资料,结合术后并发症、开腹探查结果及术后的病理结果,评估EUS-FNA对...目的探讨超声内镜引导下细针穿刺术(EUS-FNA)对胰腺占位性疾病的诊断价值和安全性。方法回顾性分析我科2011年1月至2015年10月对92例胰腺占位患者行EUS-FNA检查的病史资料,结合术后并发症、开腹探查结果及术后的病理结果,评估EUS-FNA对胰腺占位性病变术前诊断率、相关血管侵犯准确性、手术可切除性和安全性。结果全部患者均成功完成EUS-FNA操作,仅1例出现贲门黏膜轻度撕裂出血,保守治疗痊愈,无胆瘘、消化道穿孔、胰腺炎等严重并发症出现,成功获得病变组织条86例(93.5%),获得病理诊断69例(80.2%),无法诊断为17例(19.8%),肿瘤小于2cm和临床诊断为非肿瘤病例是无法获得病理诊断的两个重要因素,超声探测20例肿块与血管侧壁侵犯,准确率为83.3%(20 vs 24例),预计不可切除8例,准确性达100%。结论 EUS-FNA在进行胰腺占位病变的术前诊断是安全可行的,但诊断率偏低,对判断肿块与血管侵犯情况和可切除性上有较高的参考价值。展开更多
目的:复习肝脏尾状叶肿瘤的病例资料,评价内镜超声引导下细针穿刺(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)肝尾状叶对恶性肿瘤的诊断价值.方法:4例患者其他影像学检查发现肝脏占位,并行相应的辅助检查.总结其主...目的:复习肝脏尾状叶肿瘤的病例资料,评价内镜超声引导下细针穿刺(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)肝尾状叶对恶性肿瘤的诊断价值.方法:4例患者其他影像学检查发现肝脏占位,并行相应的辅助检查.总结其主要临床特点.肝脏尾状叶占位和相关部位行EUS-FNA,穿刺物行细胞学检查和组织学检查.内镜超声在食管胃连接处探头指向右侧扫查到肝尾状叶,穿刺肝尾状叶.结果:4例患者,男3例,女1例,年龄50岁-69岁.穿刺9个部位(肝尾状叶4,肝左叶1,胰腺2,肝门淋巴结1,腹膜后淋巴结1).9个穿刺部位中,肝门部淋巴结未获得足够的组织学标本,仅作细胞学涂片诊断腺癌转移;其他8个病灶均获得足够的组织学标本进行细胞学涂片和组织学检查,均获得明确的病理学诊断和临床诊断.所有患者均未出现并发症.诊断胰头癌并肝转移2例,胆管细胞癌并肝门淋巴结转移1例,原发性肝癌并腹腔转移1例.结论:内镜超声在食管胃连接处探头指向右侧可非常容易扫查到肝尾状叶,行EUS-FNA路径短,可精准穿刺到肝尾状叶的占位,安全性高,EUS-FNA肝尾状叶肿瘤有重要的临床价值.展开更多
Abstract Abstract Background: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a...Abstract Abstract Background: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a benign or a malignant origin. Aims: (1) To identify a combination of EUS criteria that have a sufficient sensitivity and specificity to preclude the need for EUS-FNA and (2) to assess the cost savings derived from a selective EUS-FNA approach. Methods: A total of 144 patients with esophageal carcinoma were prospectively evaluated with EUS. Accuracy of standard (hypoechoic, smooth border, round, or width > 5 mm) and modified (4 standard plus EUS identified celiac lymph nodes, > 5 lymph nodes, or EUS T3/4 tumor) criteria were compared (receiver operating characteristic curves). Resource utilization of two diagnostic strategies, routine (all patients with lymph nodes) and selective EUS-FNA (FNA only in those patients in whom the number of EUS malignant criteria provides a sensitivity and a specificity< 100% ),were compared. Results: Modified EUS criteria for lymph-node staging were more accurate than standard criteria (area under the curve 0.88 vs. 0.78, respectively). No criterion alone was predictive ofmalignancy; sensitivity and specificity reached 100% when a cutoff value of > 1 and > 6 modified criteria were used, respectively. The EUS-FNA selective approach may avoid performing FNA in 61 patients (42% ). Conclusions: Modified EUS lymph-node criteria are more accurate than standard criteria. A selective EUS-FNA approach reduced the cost by avoiding EUS-FNA in 42% of patients with esophageal carcinoma. These results require confirmation in future studies.展开更多
Abstract Abstract Background: Transbronchial needle aspiration (TBNA) and EUS-guided FNA (EUS-FNA) are minimally invasive diagnostic approaches to mediastinal lymphadenopathy. Rapid on-site cytopathologic evaluation (...Abstract Abstract Background: Transbronchial needle aspiration (TBNA) and EUS-guided FNA (EUS-FNA) are minimally invasive diagnostic approaches to mediastinal lymphadenopathy. Rapid on-site cytopathologic evaluation (ROSE) may facilitate the decision whether to proceed to a second procedure in the same session. The aim of this study was to determine the utility of TBNA with ROSE, combinedwith the option for immediate EUS-FNA in a single-session approach to mediastinal lymphadenopathy. Methods: We prospectively recruited 20 patients (12 men;mean age 66.7 ± 10.2 years) with mediastinal lymphadenopathy on CT who required cytopathologic evaluation. Bronchoscopy was first performed with TBNA and ROSE. If this was unrevealing, EUS-FNA was performed immediately afterward with ROSE. All procedures were performed with the patient under local anesthesia and sedation. Results: TBNA specimens were deemed adequate on-site in 13 patients, and EUS-FNA was performed in the remaining 7 patients. TBNA with ROSE was falsely negative in one patient. The diagnostic yield for TBNA and EUS-FNA alone was 65% and 86% , respectively. This single-session approach provided a yield of 90% , with no complications. The final diagnoses were 12 non-small-cell lung cancer, two small-cell lung cancer, one metastatic adenocarcinoma, two sarcoidosis, one tuberculosis, one lymphoma, and one with no definitive diagnosis. Conclusions: Combining TBNA with the option for EUS-FNA immediately after unrevealing TBNA gave a yield approaching that of mediastinoscopy and, therefore, may reduce the need for invasive mediastinal sampling. This single-session endoscopic approach was safe, required only local anesthesia and sedation, was convenient, and obviated the need for patients to return for a second procedure.展开更多
【据《J Gastroenterol Hepatol》2019年4月报道】题:三种不同类型支架用于超声内镜引导下经壁引流胰周积液的对比研究(作者 Wang ZJ等)超声内镜(EUS)引导下经壁引流被认为是目前治疗胰周积液(PFC)的一线方案,引流常用的支架主要有双猪...【据《J Gastroenterol Hepatol》2019年4月报道】题:三种不同类型支架用于超声内镜引导下经壁引流胰周积液的对比研究(作者 Wang ZJ等)超声内镜(EUS)引导下经壁引流被认为是目前治疗胰周积液(PFC)的一线方案,引流常用的支架主要有双猪尾塑料支架(DPPS)、全覆膜自膨式金属支架(FCSEMS)以及双蘑菇头金属支架(LMAS)三种,但是三者之间的比较性研究报道极少。展开更多
超声内镜引导下细针穿刺术(Endoscopic ultrasound fine needle aspiration,EUS-FNA)是目前获取组织细胞学诊断的一种安全可靠的技术,已用于诊断胰腺疾病。EUS-FNA术后胰腺相关并发症的发病率很低,只有0~5.0%,其中最常见的是高淀粉酶血...超声内镜引导下细针穿刺术(Endoscopic ultrasound fine needle aspiration,EUS-FNA)是目前获取组织细胞学诊断的一种安全可靠的技术,已用于诊断胰腺疾病。EUS-FNA术后胰腺相关并发症的发病率很低,只有0~5.0%,其中最常见的是高淀粉酶血症和急性胰腺炎(AP)。目前有些医院将血清淀粉酶检测作为评估EUS-FNA术后并发症的指标,但临床实践中发现EUS-FNA术后高淀粉酶血症一般会自行恢复,因此术后是否常规检测淀粉酶水平尚存争议。为此,本研究分析EUS-FNA术后高淀粉酶血症和AP的高危因素,明确EUS-FNA术后是否常规检测血清淀粉酶水平。展开更多
文摘目的探讨超声内镜引导下细针穿刺术(EUS-FNA)对胰腺占位性疾病的诊断价值和安全性。方法回顾性分析我科2011年1月至2015年10月对92例胰腺占位患者行EUS-FNA检查的病史资料,结合术后并发症、开腹探查结果及术后的病理结果,评估EUS-FNA对胰腺占位性病变术前诊断率、相关血管侵犯准确性、手术可切除性和安全性。结果全部患者均成功完成EUS-FNA操作,仅1例出现贲门黏膜轻度撕裂出血,保守治疗痊愈,无胆瘘、消化道穿孔、胰腺炎等严重并发症出现,成功获得病变组织条86例(93.5%),获得病理诊断69例(80.2%),无法诊断为17例(19.8%),肿瘤小于2cm和临床诊断为非肿瘤病例是无法获得病理诊断的两个重要因素,超声探测20例肿块与血管侧壁侵犯,准确率为83.3%(20 vs 24例),预计不可切除8例,准确性达100%。结论 EUS-FNA在进行胰腺占位病变的术前诊断是安全可行的,但诊断率偏低,对判断肿块与血管侵犯情况和可切除性上有较高的参考价值。
文摘目的:复习肝脏尾状叶肿瘤的病例资料,评价内镜超声引导下细针穿刺(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)肝尾状叶对恶性肿瘤的诊断价值.方法:4例患者其他影像学检查发现肝脏占位,并行相应的辅助检查.总结其主要临床特点.肝脏尾状叶占位和相关部位行EUS-FNA,穿刺物行细胞学检查和组织学检查.内镜超声在食管胃连接处探头指向右侧扫查到肝尾状叶,穿刺肝尾状叶.结果:4例患者,男3例,女1例,年龄50岁-69岁.穿刺9个部位(肝尾状叶4,肝左叶1,胰腺2,肝门淋巴结1,腹膜后淋巴结1).9个穿刺部位中,肝门部淋巴结未获得足够的组织学标本,仅作细胞学涂片诊断腺癌转移;其他8个病灶均获得足够的组织学标本进行细胞学涂片和组织学检查,均获得明确的病理学诊断和临床诊断.所有患者均未出现并发症.诊断胰头癌并肝转移2例,胆管细胞癌并肝门淋巴结转移1例,原发性肝癌并腹腔转移1例.结论:内镜超声在食管胃连接处探头指向右侧可非常容易扫查到肝尾状叶,行EUS-FNA路径短,可精准穿刺到肝尾状叶的占位,安全性高,EUS-FNA肝尾状叶肿瘤有重要的临床价值.
文摘Abstract Abstract Background: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a benign or a malignant origin. Aims: (1) To identify a combination of EUS criteria that have a sufficient sensitivity and specificity to preclude the need for EUS-FNA and (2) to assess the cost savings derived from a selective EUS-FNA approach. Methods: A total of 144 patients with esophageal carcinoma were prospectively evaluated with EUS. Accuracy of standard (hypoechoic, smooth border, round, or width > 5 mm) and modified (4 standard plus EUS identified celiac lymph nodes, > 5 lymph nodes, or EUS T3/4 tumor) criteria were compared (receiver operating characteristic curves). Resource utilization of two diagnostic strategies, routine (all patients with lymph nodes) and selective EUS-FNA (FNA only in those patients in whom the number of EUS malignant criteria provides a sensitivity and a specificity< 100% ),were compared. Results: Modified EUS criteria for lymph-node staging were more accurate than standard criteria (area under the curve 0.88 vs. 0.78, respectively). No criterion alone was predictive ofmalignancy; sensitivity and specificity reached 100% when a cutoff value of > 1 and > 6 modified criteria were used, respectively. The EUS-FNA selective approach may avoid performing FNA in 61 patients (42% ). Conclusions: Modified EUS lymph-node criteria are more accurate than standard criteria. A selective EUS-FNA approach reduced the cost by avoiding EUS-FNA in 42% of patients with esophageal carcinoma. These results require confirmation in future studies.
文摘Abstract Abstract Background: Transbronchial needle aspiration (TBNA) and EUS-guided FNA (EUS-FNA) are minimally invasive diagnostic approaches to mediastinal lymphadenopathy. Rapid on-site cytopathologic evaluation (ROSE) may facilitate the decision whether to proceed to a second procedure in the same session. The aim of this study was to determine the utility of TBNA with ROSE, combinedwith the option for immediate EUS-FNA in a single-session approach to mediastinal lymphadenopathy. Methods: We prospectively recruited 20 patients (12 men;mean age 66.7 ± 10.2 years) with mediastinal lymphadenopathy on CT who required cytopathologic evaluation. Bronchoscopy was first performed with TBNA and ROSE. If this was unrevealing, EUS-FNA was performed immediately afterward with ROSE. All procedures were performed with the patient under local anesthesia and sedation. Results: TBNA specimens were deemed adequate on-site in 13 patients, and EUS-FNA was performed in the remaining 7 patients. TBNA with ROSE was falsely negative in one patient. The diagnostic yield for TBNA and EUS-FNA alone was 65% and 86% , respectively. This single-session approach provided a yield of 90% , with no complications. The final diagnoses were 12 non-small-cell lung cancer, two small-cell lung cancer, one metastatic adenocarcinoma, two sarcoidosis, one tuberculosis, one lymphoma, and one with no definitive diagnosis. Conclusions: Combining TBNA with the option for EUS-FNA immediately after unrevealing TBNA gave a yield approaching that of mediastinoscopy and, therefore, may reduce the need for invasive mediastinal sampling. This single-session endoscopic approach was safe, required only local anesthesia and sedation, was convenient, and obviated the need for patients to return for a second procedure.
文摘【据《J Gastroenterol Hepatol》2019年4月报道】题:三种不同类型支架用于超声内镜引导下经壁引流胰周积液的对比研究(作者 Wang ZJ等)超声内镜(EUS)引导下经壁引流被认为是目前治疗胰周积液(PFC)的一线方案,引流常用的支架主要有双猪尾塑料支架(DPPS)、全覆膜自膨式金属支架(FCSEMS)以及双蘑菇头金属支架(LMAS)三种,但是三者之间的比较性研究报道极少。
文摘超声内镜引导下细针穿刺术(Endoscopic ultrasound fine needle aspiration,EUS-FNA)是目前获取组织细胞学诊断的一种安全可靠的技术,已用于诊断胰腺疾病。EUS-FNA术后胰腺相关并发症的发病率很低,只有0~5.0%,其中最常见的是高淀粉酶血症和急性胰腺炎(AP)。目前有些医院将血清淀粉酶检测作为评估EUS-FNA术后并发症的指标,但临床实践中发现EUS-FNA术后高淀粉酶血症一般会自行恢复,因此术后是否常规检测淀粉酶水平尚存争议。为此,本研究分析EUS-FNA术后高淀粉酶血症和AP的高危因素,明确EUS-FNA术后是否常规检测血清淀粉酶水平。
