术中超声引导精准活检对胰头肿块诊断价值的探讨

目的探讨术中超声引导下精准Tru-cut活检在胰头实性肿块病理学诊断中的价值。方法对徐州医学院附属宿迁医院肝胆胰脾外科2010年8月至2011年8月期间收治的胰头实性肿块患者行术中超声引导下精准Tru-cut活检,共28例患者,男20例,女8例,年龄34～78岁,平均64岁;肿块最大径≤1.5 cm者5例(0.8～1.5 cm,平均1.2 cm,S组),1.5 cm<肿块最大径≤3.0 cm者7例(1.6～3.0 cm,平均2.5 cm,M组),肿块最大径>3.0 cm者16例(3.2～6.8 cm,平均4.8 cm,L组),每一肿块活检3针,每一条组织条均行快速冰冻检查,其结果与术后大标本石蜡切片病理结果分别比较。结果以患者为观察单位,所有病例诊断符合率为100%,无假阳性及假阴性。以单个组织条病理结果为观察单位,仅1条符合(1/3)、仅2条符合(2/3)和3条全符合(3/3)者分别为:S组是3例(3/5)、2例(2/5)、0例(0/5);M组是0例(0/7)、5例(5/7)、2例(2/7);L组是0例(0/16)、4例(4/16)、12例(12/16);在小病灶组(S组+M组)中的单条组织标本的假阴性率高于L组(χ2=9.833,P=0.002)。病灶小易出现单次穿刺假阴性结果。结论术中超声引导下精准Tru-cut活检能够准确确定胰头肿块的病理学诊断,安全有效,可为手术决策提供可靠依据。

Value of Intraoperative Ultrasound Guided Precise Tru-Cut Biopsy for Diagnosis of Solid Pancreatic Masses

Objective To explore the value of pathologic diagnosis for pancreatic head mass by using recise Tru-cut biopsy under intraoperative ultrasound guided. Methods Twenty-eight patients with solid pancreatic masses in People’s Hospital of Suqian,Affiliated Hospital Xuzhou Medical College from August 2010 to August 2011 were performed precise Tru-cut biopsy under intraoperative ultrasound guided.In all patients of 28 cases,male 20 cases and female 8 cases,the male-to-female ratio was 5∶2.The patients’ age was 34-78 years old(mean age:64 years old).Twenty-eight patients were divided into three groups based upon the greatest dimension of the masses as follows:equal or less than 1.5 cm(group S,5 cases),1.5-3.0 cm(group M,7 cases),and greater than 3.0 cm(group L,16 cases).Three needle passes in each mass were performed.The results of postoperative pathologic findings were compared with specimens in paraffin sections.Results In all cases of 28,the diagnostic coincidence rate was 100%,there were no false positive finding and false negative.The coincidence ratio for pathological diagnosis of tissues with only 1 strip sample(1/3),only 2 strip samples(2/3),and with 3 strip samples(3/3) were 3/5,2/5,and 0/0,respectivly in S group,0/0,5/7,and 2/7,respectivly in M group,and 0/0,4/16,and 12/16,respectivly in L group.The false negative rate of single strip sample in S group and M group was higher than that in L group(χ2 = 9.833,P = 0.002).There was false negative finding with master single test in small focus of infection.Conclusion Precise Tru-cut biopsy under intraoperative ultrasound guided is a safe and highly accurate method for pathological diagnosis of patients with solid pancreatic lesions,especially in small lesions,it is worthy of clinical application.