超声引导经皮粗针穿刺活检胰腺实性占位病变的安全性及临床价值

摘要

目的：探讨超声引导经皮粗针穿刺活检胰腺实性占位病变的安全性和临床价值。方法对51例胰腺实性占位病变患者行超声引导经皮粗针穿刺，以穿刺样本的组织病理学及免疫组织化学结果或随访1年以上临床诊断为最终诊断，分析其临床价值和不良反应。结果47例取材满意（92.2%），4例取材不满意（7.8%）。49例穿刺组织病理明确诊断（96.1%），2例不能明确诊断（3.9%）。46例无不适（90.2%），3例上腹疼痛（疼痛强度评分1～3分），1例疼痛明显（疼痛强度评分6分），1例血清淀粉酶增高。超声引导经皮粗针穿刺组织病理学鉴别病灶良恶性的敏感性为90.0%，特异性为100%，诊断准确率90.2%，阳性预测值100%，阴性预测值16.7%，正确指数0.90。结论超声引导经皮粗针穿刺活检胰腺实性占位病变安全、准确，为临床确诊胰腺良恶性病变提供了简单可靠的方法。%Objective To explore the safety and value of percutaneous core needle biopsies guided by ultrasound in pancreatic solid masses.Methods Core needle punctures with biopsy-gun were percutaneously performed under the guidance of ultrasound in 51 cases of pancreatic solid masses and analyze the clinical value and adverse effect. The final diagnosis of all patient were relied on the histopathological and immunohistochemical findings,or the clinical diagnosis followed-up more than one year. Results The obtained samples were macroscopically big enough to make a histopathological diagnosis in 47 cases (92.2%) and unsatisfied samples in 4 cases(7.8%).The definite diagnosis were histopathologically made out in 49 cases(96.1%)and undefinite diagnosis in 2 patients(3.9%).After the puncture procedures,there were no complains in 46 cases(90.2%) excluding the other 5 patients who including three complained mild pain in abdomen(NRS 1~3),one severe pain in abdomen(NRS 6)that need to be alleviated management,and one with the pancreatic amylase level slightly increased.In distinguishing malignant or benign lesions depending on the histopathological findings of samples obtained by the punctures procedures under the guidance of ultrasound,the sensitivity,specificity,consistency rate,positive predictive value,negative predictive value and Youden index was 90.0%,100%, 90.2%,100%,16.7% and 0.90,respectively.Conclusion The percutaneous core needle biopsy under the guidance of ultrasound is a safe and reliable way for clinic to distinguish the malignant and benign solid lesions in pancreas.