目的探讨超声内镜(EUS)引导下穿刺抽吸联合硬化剂注射术对肝囊肿患者炎症因子的影响。方法2020年6月-2022年6月安阳市第三人民医院收治的肝囊肿患者90例,随机数字表法分为对照组和观察组各45例,依次行硬化剂注射术或者EUS引导下穿刺抽...目的探讨超声内镜(EUS)引导下穿刺抽吸联合硬化剂注射术对肝囊肿患者炎症因子的影响。方法2020年6月-2022年6月安阳市第三人民医院收治的肝囊肿患者90例,随机数字表法分为对照组和观察组各45例,依次行硬化剂注射术或者EUS引导下穿刺抽吸联合硬化剂注射术,观察48周。比较两组治疗前及治疗后7 d血生化指标及炎因子水平,分析两组治疗后12周总有效率及不良反应发生率,并观察两组治疗后48周肝囊肿复发率。结果观察组治疗后12周末总有效率为95.56%,高于对照组的82.22%(P<0.05)。两组治疗后7 d ALT、AST、ALP及TBil无显著差异(P>0.05)。观察组治疗后7 d血清CRP、TNF-α和IL-1β水平分别为(53.83±6.24)mg/L、(260.80±18.40)ng/L和(91.04±5.10)ng/L,显著低于对照组[(56.67±5.96)mg/L、(268.92±16.93)ng/L和(93.22±4.87)ng/L,P<0.05]。观察组不良反应发生率为2.22%,低于对照组的17.78%(P<0.05)。观察组治疗后48周末肝囊肿复发率为2.27%,低于对照组的17.95%(P<0.05)。结论相较于硬化剂注射术,EUS引导下穿刺抽吸联合硬化剂注射术治疗肝囊肿临床疗效更为确切,可缓解机体炎症反应,减少并发症及复发,对患者肝功能并无明显影响。展开更多
目的前瞻性地评价超声内镜引导下细针抽吸活检(endoscopic ultrasound-guided fine needleaspiration,EUS-FNA)在胰腺疾病诊断中的价值及影响其诊断能力的潜在因素分析。方法 2010年9月至2011年8月间就诊于复旦大学附属中山医院内镜中心...目的前瞻性地评价超声内镜引导下细针抽吸活检(endoscopic ultrasound-guided fine needleaspiration,EUS-FNA)在胰腺疾病诊断中的价值及影响其诊断能力的潜在因素分析。方法 2010年9月至2011年8月间就诊于复旦大学附属中山医院内镜中心,经影像学诊断(CT或MRI)为胰腺病变、拟行EUS-FNA的44例患者连续性地纳入本研究。详细记录患者的年龄、性别、病变位置、病变大小、穿刺次数,评价是否获取足够样本供细胞学或组织病理学诊断及穿刺相关并发症等。结果 44例患者中,42例成功实行EUS-FNA(95.5%,42/44),病灶的平均最大直径为(44.7±18.2)mm。31例获得肉眼可见的组织条;意向性分析结果显示,34例穿刺样本(77.3%,34/44)足够用于细胞或组织病理学诊断,包括31例患者获得明确的细胞或组织病理学恶性肿瘤依据,3例诊断为胰腺炎症。病灶的位置、大小与穿刺成功率、明确病理学诊断的获得率无明显关系;而穿刺过程中获得肉眼可见组织样本病例的明确病理学诊断获得率明显高于未获得者(P=0.000)。2例患者于穿刺时发生穿刺点渗血(4.8%,2/42),通过电凝及止血夹处理好转。结论在胰腺疾病的诊断中,EUS-FNA具有良好的安全性和有效性。如何在安全的前提下获取更多的组织量用于病理学评估是提高EUS-FNA诊断能力的关键。展开更多
目的:探讨分析超声内镜引导下细针穿刺抽吸术(EUS-FNA)在胰腺占位性病变的安全性和有效性。方法:回顾性分析2019年6月至2020年6月收治的40例胰腺占位性病变患者的临床病例,均行超声内镜引导下细针穿刺抽吸术(EUS-FNA)后病理诊断,分析所...目的:探讨分析超声内镜引导下细针穿刺抽吸术(EUS-FNA)在胰腺占位性病变的安全性和有效性。方法:回顾性分析2019年6月至2020年6月收治的40例胰腺占位性病变患者的临床病例,均行超声内镜引导下细针穿刺抽吸术(EUS-FNA)后病理诊断,分析所有患者的穿刺病理结果、病灶部位、病灶直径,探讨EUS-FNA诊断胰腺占位性病变的价值。结果:病理结果显示胰腺癌21例、炎症13例、实性假乳头状瘤3例、不典型增生2例、神经内分泌癌1例。病灶部位:胰头20例、胰颈4例、胰体11例、胰尾5例。病灶直径:10~20 mm 4例、20~30 mm 12例、>30 mm 24例。EUS-FNA诊断胰腺占位性病变(胰腺癌、非胰腺癌)灵敏度、特异度、阳性预测值、阴性预测值、准确性、不同性质病灶(胰腺癌、非胰腺癌)的诊断效果差异无统计学意义(P>0.05)。穿刺术后出血1例,未出现感染、穿孔等并发症。结论:超声内镜引导下细针穿刺抽吸术在胰腺占位性病变的诊断中安全、有效,诊断的特异度较高,但灵敏度较低,需要进一步改进,推广于临床。展开更多
Background:EUS-guided FNA is effective for establishing tissue diagnosis in suspected pancreatic cancer.However,data on the frequency of major complications following EUS-FNA are limited.Objective:To evaluate the freq...Background:EUS-guided FNA is effective for establishing tissue diagnosis in suspected pancreatic cancer.However,data on the frequency of major complications following EUS-FNA are limited.Objective:To evaluate the frequency of major complications after EUS-FNA of solid pancreatic masses.Design:Prospective cohort study.Setting:Tertiary University based referral center for pancreatico-biliary disorder.Patients:Consecutive patients who underwent EUS-FNA of a solid pancreatic over a 42-month period.All immediate complications were recorded by the endosonographer.Late complications were assessed at 72 hours and at 30-days after the procedure.Main Outcomes Measurements:Major complications were defined as acute pancreatitis,bleeding,infection,perforation,use of reversal medication,hospitalization or death.Results:A total of 355 consecutive patients with a solid pancreatic mass underwent EUS-FNA.Major complications were encountered in 9 patients(2.54%,95%CI 1.17-4.76).Acute pancreatitis occurred in 3 of 355(0.85 %,95%CI 0.17-2.45);2 patients were hospitalized,and 1 patient recovered with outpatient analgesics.Three patients were admitted for severe pain after the procedure;all were treated with analgesics and subsequently discharged with no sequela.Two patients(0.56%,95%CI 0.07-2.02)developed fever and were admitted for intravenous antibiotics;1 patient recovered with intravenous antibiotics and the other required surgical debridement for necrosis.One patient required the use of reversal medication.Overall,1.97%(95%CI 0.80-4.02)of the patients were hospitalized for complications(range 1-16 days).None of the patients experienced clinically significant hemorrhage,perforation,or death.No clear predisposing risk factors were identified.Limitations:Lack of surgical gold standard and referral to a tertiary center.Conclusions:EUS-FNA of solid pancreatic masses infrequently leads to major complications.Our results can be used by endosonographers to counsel patients before EUS-FNA of solid pancreatic masses.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
为提高超声内镜引导细针穿刺抽吸/活检术(endoscopic ultrasound-guided fine-needle aspiration/biopsy,EUS-FNA/B)诊断准确率,快速现场评估(rapid on site evaluation,ROSE)被应用于该操作中,通过细胞病理医师现场评估标本取材满意度...为提高超声内镜引导细针穿刺抽吸/活检术(endoscopic ultrasound-guided fine-needle aspiration/biopsy,EUS-FNA/B)诊断准确率,快速现场评估(rapid on site evaluation,ROSE)被应用于该操作中,通过细胞病理医师现场评估标本取材满意度及标本的良恶性,让内镜医师及时获得反馈,以提高诊断准确率、减少不必要的穿刺。由于许多内镜中心无法实现细胞病理医师进行ROSE,目前逐渐出现内镜医师进行ROSE。内镜医师能否胜任ROSE,其诊断效能能否与细胞病理医师相媲美值得探讨。文中结合近年来文献进展,对内镜医师在胰腺实性占位EUS-FNA/B标本快速评估中的作用进行了综述。展开更多
文摘目的探讨超声内镜(EUS)引导下穿刺抽吸联合硬化剂注射术对肝囊肿患者炎症因子的影响。方法2020年6月-2022年6月安阳市第三人民医院收治的肝囊肿患者90例,随机数字表法分为对照组和观察组各45例,依次行硬化剂注射术或者EUS引导下穿刺抽吸联合硬化剂注射术,观察48周。比较两组治疗前及治疗后7 d血生化指标及炎因子水平,分析两组治疗后12周总有效率及不良反应发生率,并观察两组治疗后48周肝囊肿复发率。结果观察组治疗后12周末总有效率为95.56%,高于对照组的82.22%(P<0.05)。两组治疗后7 d ALT、AST、ALP及TBil无显著差异(P>0.05)。观察组治疗后7 d血清CRP、TNF-α和IL-1β水平分别为(53.83±6.24)mg/L、(260.80±18.40)ng/L和(91.04±5.10)ng/L,显著低于对照组[(56.67±5.96)mg/L、(268.92±16.93)ng/L和(93.22±4.87)ng/L,P<0.05]。观察组不良反应发生率为2.22%,低于对照组的17.78%(P<0.05)。观察组治疗后48周末肝囊肿复发率为2.27%,低于对照组的17.95%(P<0.05)。结论相较于硬化剂注射术,EUS引导下穿刺抽吸联合硬化剂注射术治疗肝囊肿临床疗效更为确切,可缓解机体炎症反应,减少并发症及复发,对患者肝功能并无明显影响。
文摘目的:探讨分析超声内镜引导下细针穿刺抽吸术(EUS-FNA)在胰腺占位性病变的安全性和有效性。方法:回顾性分析2019年6月至2020年6月收治的40例胰腺占位性病变患者的临床病例,均行超声内镜引导下细针穿刺抽吸术(EUS-FNA)后病理诊断,分析所有患者的穿刺病理结果、病灶部位、病灶直径,探讨EUS-FNA诊断胰腺占位性病变的价值。结果:病理结果显示胰腺癌21例、炎症13例、实性假乳头状瘤3例、不典型增生2例、神经内分泌癌1例。病灶部位:胰头20例、胰颈4例、胰体11例、胰尾5例。病灶直径:10~20 mm 4例、20~30 mm 12例、>30 mm 24例。EUS-FNA诊断胰腺占位性病变(胰腺癌、非胰腺癌)灵敏度、特异度、阳性预测值、阴性预测值、准确性、不同性质病灶(胰腺癌、非胰腺癌)的诊断效果差异无统计学意义(P>0.05)。穿刺术后出血1例,未出现感染、穿孔等并发症。结论:超声内镜引导下细针穿刺抽吸术在胰腺占位性病变的诊断中安全、有效,诊断的特异度较高,但灵敏度较低,需要进一步改进,推广于临床。
文摘Background:EUS-guided FNA is effective for establishing tissue diagnosis in suspected pancreatic cancer.However,data on the frequency of major complications following EUS-FNA are limited.Objective:To evaluate the frequency of major complications after EUS-FNA of solid pancreatic masses.Design:Prospective cohort study.Setting:Tertiary University based referral center for pancreatico-biliary disorder.Patients:Consecutive patients who underwent EUS-FNA of a solid pancreatic over a 42-month period.All immediate complications were recorded by the endosonographer.Late complications were assessed at 72 hours and at 30-days after the procedure.Main Outcomes Measurements:Major complications were defined as acute pancreatitis,bleeding,infection,perforation,use of reversal medication,hospitalization or death.Results:A total of 355 consecutive patients with a solid pancreatic mass underwent EUS-FNA.Major complications were encountered in 9 patients(2.54%,95%CI 1.17-4.76).Acute pancreatitis occurred in 3 of 355(0.85 %,95%CI 0.17-2.45);2 patients were hospitalized,and 1 patient recovered with outpatient analgesics.Three patients were admitted for severe pain after the procedure;all were treated with analgesics and subsequently discharged with no sequela.Two patients(0.56%,95%CI 0.07-2.02)developed fever and were admitted for intravenous antibiotics;1 patient recovered with intravenous antibiotics and the other required surgical debridement for necrosis.One patient required the use of reversal medication.Overall,1.97%(95%CI 0.80-4.02)of the patients were hospitalized for complications(range 1-16 days).None of the patients experienced clinically significant hemorrhage,perforation,or death.No clear predisposing risk factors were identified.Limitations:Lack of surgical gold standard and referral to a tertiary center.Conclusions:EUS-FNA of solid pancreatic masses infrequently leads to major complications.Our results can be used by endosonographers to counsel patients before EUS-FNA of solid pancreatic masses.
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.
文摘为提高超声内镜引导细针穿刺抽吸/活检术(endoscopic ultrasound-guided fine-needle aspiration/biopsy,EUS-FNA/B)诊断准确率,快速现场评估(rapid on site evaluation,ROSE)被应用于该操作中,通过细胞病理医师现场评估标本取材满意度及标本的良恶性,让内镜医师及时获得反馈,以提高诊断准确率、减少不必要的穿刺。由于许多内镜中心无法实现细胞病理医师进行ROSE,目前逐渐出现内镜医师进行ROSE。内镜医师能否胜任ROSE,其诊断效能能否与细胞病理医师相媲美值得探讨。文中结合近年来文献进展,对内镜医师在胰腺实性占位EUS-FNA/B标本快速评估中的作用进行了综述。
