不用针芯的超声内镜引导下细针穿刺活检的临床研究

摘要

Objective To compare the effect of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) with (S + ) and without ( S - ) a stylet for lesions of, and arotmd gatrointestinal tract.Methods 97 consecutive patients with 116 lesions in the gastrointestinal wall and around the lumen were enrolled in this prospective study.Lesions were randomized to EUS-FNA with (S + ) and without ( S - ) a styler groups.Pathological diagnose rate, immunohistological diagnose rate and time spend were compared between the two groups.Results 115 cytologic diagnoses were obtained in all 116 lesions/sites.81 (73.6％) immunohitological diagnoses were obtained in 110 solid lesions, and S( + ) and S( - ) group were 69.6％ (39/56) and 77.8％ (42/54) respectively, there was no significant difference between the two groups ( P ＞ 0.05 ).Pathological diagnose rate of S( + ) and S( - ) group were 89.8％ and 91.2％ respectively, there was no significant difference between the two groups ( P ＞ 0.05 ).Time spend in S( - ) group (6.8 ± 2.2 min) was significantly shorter than S ( + ) group ( 8.3 ± 1.9min) ( P = 0.00, 95％ CI = -3.17 ～ -0.67).Conclusion Without the use of the stylet does not decrease the yield and pathological diagnose of EUS-FNA, and dose shorten time spend on EUS-FNA.%目的 探讨超声内镜引导下细针穿刺活检(EUS-FNA)过程中不用针芯是否对病理学结果有影响.方法 将病例前瞻性随机分为用针芯组和不用针芯组,比较穿刺物切片能否作免疫组化、病理学确诊的比例以及穿刺过程所用时间等.然后全部不用针芯作EUS-FNA,判断其有效性.结果 随机对照研究中共97例患者116处病灶接受了EUS-FNA,穿刺部位为上消化道和直肠管壁肿瘤及其周围器官病灶.116处病变中115处(99.1%)穿刺物能作细胞学涂片.110例实性或囊实性病变中,有81处(73.6%)标本能作免疫组化.不用针芯组59处部位,用针芯组57处部位.两组病理学诊断确定的比例分别为89.8%和91.2%,无显著性统计学差异(P＞0.05);共110例实性肿块接受了EUS-FNA,不用针芯组和用针芯组能作免疫组化的比例分别为69.6%和77.8%,无显著性统计学差异(P＞0.05);不用针芯组和用针芯组穿刺所用时间分别为6.8±2.2 min和8.3±1.9 min,前者明显短于后者,有显著性统计学意义(P=0.00,95%CI=-3.17～-0.67).所有穿刺的患者均未出现明显的并发症.结论 不用针芯组与用针芯组进行EUS-FNA,获取组织的量和病理学诊断结果无差异.不用针芯可以节省时间,减轻患者的不适感觉,用于胃肠道管壁肿瘤或周围器官病灶的明确诊断,是安全有效的.