超声内镜引导下细针抽吸活检术在胰腺占位性病变中的应用

  目的  探讨超声内镜引导下细针抽吸活检术（EUS-FNA）在胰腺占位性病变中的临床应用特点。  方法  选择2018年1月~2022年1月于本院因可疑胰腺占位性病变行EUS-FNA检查的55例患者作为研究对象，患者年龄62.91±11.21岁，其中男性29例、女性26例。以穿刺样本的组织学病理结果为金标准，分析行EUS-FNA检查患者的一般临床资料及其病变特点、胰管情况、穿刺次数及术后并发症等。评价EUS-FNA诊断胰腺占位性病变的敏感度、特异性、准确度，以及影响准确性的临床因素。  结果  55例患者均成功进行EUS-FNA，穿刺成功率100%，所有患者获得穿刺病理。术后不良反应2例，其中1例为腹痛，1例为高淀粉酶血症，经临床常规处理后均恢复良好。经EUS-FNA诊断明确的有48例（87.27%），诊断未明确的有7例（12.73%），诊断敏感度为92.31%（48/52），特异性为100%（3/3），准确度为92.73%（51/55），阳性预测值为100%（48/48），阴性预测值为42.86%（3/7）；EUS-FNA的准确性与患者年龄、胰管扩张情况有关（P < 0.05），与性别、血糖、肿瘤标记物、病灶性状、病变大小、部位、穿刺针数、细胞学检查方法等无关（P > 0.05）。  结论  EUS-FNA对胰腺占位性病变诊断的敏感度、特异性、准确度均很高，并发症少见且轻微，为临床提供了有效的诊断方法。 

Clinical application of endoscopic ultrasound guided fine needle aspiration biopsy in pancreatic space-occupying lesions

  Objective  To investigate the clinical application of endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) biopsy in pancreatic space occupying lesions.  Methods  Fifty-five patients who underwent EUS-FNA examination for suspected pancreatic space-occupying lesions in the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2022 were screened, with an average age of 62.91±11.21 years, including 29 males and 26 females. The general clinical data, lesion characteristics, pancreatic duct conditions, puncture times and postoperative complications of patients undergoing EUS-FNA were analyzed, with the histopathological results of puncture samples as the gold standard. We evaluated the sensitivity, specificity, and accuracy of EUS-FNA in diagnosing pancreatic space-occupying lesions, as well as the clinical factors affecting the accuracy.  Results  EUS-FNA was successfully performed in all these 55 patients, the puncture success rate was 100%, and puncture pathology was obtained in all patients. Postoperative adverse reactions occurred in 2 cases, including abdominal pain in 1 case and hyperamylasemia in 1 case. All patients recovered well after routine clinical treatment. Forty-eight cases (87.27%) were definitely diagnosed by EUS-FNA, and 7 cases (12.73%) were not definitely diagnosed. The diagnostic sensitivity was 92.31% (48/52), specificity was 100% (3/3), accuracy was 92.73% (51/55), positive predictive value was 100% (48/48), negative predictive value was 42.86% (3/7). The accuracy of EUS-FNA was related to the patient's age and pancreatic duct dilatation (P < 0.05), but not gender, blood glucose, tumor markers, lesion characteristics, lesion size, location, times of puncture needles, cytological examination methods (P > 0.05).  Conclusion  EUS-FNA has high sensitivity, specificity and accuracy in the diagnosis of pancreatic space occupying lesions. The complications are rare and mild, which provides an effective diagnostic method for clinical practice.