RCAS1在胰腺癌诊断中的作用

目的 评价SiSo细胞表达的受体结合癌抗原(RCAS1)在胰腺癌诊断中的作用.方法 应用酶联免疫吸附分析法检测46例胰腺癌患者、18例慢性胰腺炎患者和20名健康人血清中RCAS1、CA19-9和CA242的含量.用ROC曲线法对检测结果进行分析.应用免疫组织化学染色法对32例胰腺癌、10例慢性胰腺炎以及6例正常胰腺组织切片进行染色,观察RCAS1在胰腺癌和正常胰腺组织中的表达情况.同时对结果进行统计学分析.结果 3种肿瘤标志物的水在胰腺癌组均高于慢性胰腺炎组和正常对照组,且差异均有统计学意义(P＜0.01).运用ROC曲线法对3种肿瘤标志物的检测结果进行处理.RCAS1、CA19-9和CA242的曲线下面积分别为0.826、0.804和0.737.分层分析表明,RCAS1和CA19-9在有梗阻性黄疸组高于无梗阻性黄疸组(P＜0.01),CA19-9在手术无法切除组高于手术可切除组(P＜0.01).胰腺癌组织中RCAS1表达的阳性率为87.5%,慢性胰腺炎组织为40.0%,两组差异有统计学意义(P＜0.05).结论 RCAS1在胰腺癌组织中高表达,作为血清肿瘤标志物对胰腺癌的综合诊断能力优于CA19-9和CA242,若同时联合检测CA19-9,则对提高胰腺癌早期诊断和术前可切除性评估准确率有一定的临床价值.     

肿瘤血清标记物骨桥蛋白用于诊断胰腺癌研究

目的评价骨桥蛋白(OPN)作为肿瘤血清标记物在胰腺癌诊断中的作用。方法收集北京协和医院胰腺外科2004年2月至2006年2月相关临床住院病人的血清64例,运用ELISA法检测其中的46例胰腺癌病人、18例慢性胰腺炎病人以及20名健康人的血清中的OPN、CA19-9和CA242的含量。用ROC曲线法对检测结果进行分析,同时对结果进行统计学检验。结果三种肿瘤标记物的水平在胰腺癌组均高于慢性胰腺炎组,且差异均有显著性意义(P<0.01)。运用ROC曲线法对三种肿瘤标记物的检测结果进行处理。OPN、CA19-9和CA242的AUC(area under curve)分别为0.788、0.808和0.737。分层分析表明,OPN和CA19-9在手术无法切除组高于手术可切除组(P<0.01)。结论OPN在胰腺癌血清学诊断中有临床意义,若同时联合检测CA19-9,则对胰腺癌术前可切除性评估有一定的临床价值。     

Tumour markers in pancreatic cancer

Patients with pancreatic cancer usually lack signs and symptoms in the early course of the disease. Even when malignancy is suspected, differential diagnosis between benign and malignant pancreatic disorders may be difficult with current methods. An increasing interest has been focused on the utility of immunological tumour markers. CEA has been widely used since the early seventies, but the results in diagnosis of pancreatic cancer have been disappointing. Tumour marker tests for CA 19-9 and CA 50 are based on monoclonal antibodies to colonic carcinoma cell lines. CA 19-9 and CA 50 are strongly expressed in most tissue specimens from pancreatic carcinomas, but are also found in normal pancreas and benign pancreatic diseases. The CA 19-9 and CA 50 antigens are shed or released into the circulation, and are found in increased concentrations in 70-80% of patients with pancreatic cancer. Also 50-65% of patients with small resectable carcinomas have elevated CA 19-9 and CA 50 levels, although very high serum concentrations usually indicate advanced disease. Slightly elevated serum CA 19-9 and CA 50 levels are seen in some patients with benign pancreatic diseases, more often in acute than in chronic pancreatitis. Elevated values are often observed in patients with benign obstruction of the common bile duct, particularly in patients with cholangitis. In patients with jaundice of hepatocellular origin, the CA 19-9 and CA 50 levels are lower than in extrahepatic cholestasis. CA 19-9 and CA 50 have better diagnostic accuracy for pancreatic cancer than CEA, CA 125, DU-PAN-2, TPA and PSTI/TATI. However, the sensitivities and specificities of CA 19-9 and CA 50 are too low for screening of an asymptomatic population. Nevertheless, CA 19-9 and CA 50 have in our experience shown to be useful complements to other diagnostic methods in symptomatic patients with suspicion of pancreatic cancer. Combinations of different markers improve the sensitivity only slightly compared to the use of CA 19-9 or CA 50 alone. Follow-up using CA 19-9 and CA 50 is a simple and sensitive way of monitoring the postoperative course of patients with pancreatic cancer, and may give a lead time of several months for a recurrence compared to conventional methods.     

急性坏死性胰腺炎继发感染的早期诊断

目的 探讨急性坏死性胰腺炎继发感染的早期诊断方法。方法 对１３例急性坏死性胰腺炎的临床、ＣＴ影像学、ＣＴ引导下细地穿针（ＦＮＡ）结合ＰＣＲ微生物学检查，诊断胰腺感染的敏感性、特异性进行前瞻性比较研究。结果 ９例最终诊断为胰腺感染，４例为胰腺未感染。根据临床症状体征及常规实验室检查，诊断胰腺感染的敏感性为１００％（９／９），特异性为２５％（１／４）；ＣＴ 泡征诊断胰腺感染的敏感性为５５．６％（５／９     

Value of serum CA 19-9 determination in the diagnosis of pancreatic carcinoma

In this communication, serum Ca19-9 was determined in a series of patients with benign and malignant GI diseases. It was found that CA19-9 was positive in 86.7% of 30 pancreatic cancer patients with an average level of 427.53 u/ml, the value was statistically different from that found in non-malignant control group. Serum CA19-9 determination, in this series, helped to make definite diagnosis of pancreatic cancer in 6 cases, in which B-mode ultrasonography failed to diagnose, and in another 3 cases in which CT scanning was unable to 'see' the tumors. The combination of CA19-9, B-mode ultrasonography, and CT made definite diagnosis in 100% of all 30 pancreatic cancer patients. The authors discussed the significance of CA19-9 determination in the diagnosis and differential diagnosis of pancreatic cancer.     

Management of pancreatic mass accompanying chronic pancreatitis

We report two patients with focal, chronic pancreatitis that was diagnosed by dynamic computed tomography (CT) combined with intraoperative biopsy. In case 1, serum carbohydrate antigen (CA) 19-9 level rose to 160 U/ml. Abdominal ultrasonography, CT, and magnetic resonance imaging demonstrated a mass, of 4.5 cm in diameter, in the pancreatic head. On dynamic CT, the mass was enhanced similarly to the normal pancreatic parenchyma. In case 2, dynamic CT demonstrated a mass, of 3.0 cm in diameter, in the pancreatic head, which was enhanced similarly to the normal pancreatic parenchyma. From such characteristics of enhancement, both masses were suspected to be chronic pancreatitis rather than cancer, and the diagnosis was confirmed by intraoperative biopsy. Three years in case 1 and 2 years in case 2 have passed since their operations, and the size of each mass has not changed. With the use of dynamic CT combined with intraoperative biopsy, focal chronic pancreatitis could be diagnosed more accurately, and this may lead to a reduction in unnecessary pancreatic resection. Received: November 16, 2001 / Accepted: February 8, 2002     

Cancer antigens 19-9 and 125 in the differential diagnosis of pancreatic mass lesions

HYPOTHESIS: Accurate differentiation between inflammatory and neoplastic tumors of the pancreas remains a diagnostic dilemma for surgeons. The aim of the study was to assess the utility of 2 neoplastic markers, cancer antigen (CA) 19-9 and CA 125, in the differential diagnosis of pancreatic tumors. DESIGN: The patients were assigned to a malignant or benign group based on cytological and histological evaluation of pancreatic lesion samples. The serum from each patient was tested for CA 19-9 and CA 125.Setting and PATIENTS: One hundred ten patients with heterogeneous pancreatic lesions (inflammatory and malignant tumors) treated at a surgical department of a university hospital were analyzed. INTERVENTIONS: Samples for cytological and histological evaluation were taken during ultrasonography-guided fine-needle aspiration biopsy or open surgery. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of each test in the differential diagnosis of pancreatic tumors were determined. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of the CA 19-9 test were 80.8%, 89.1%, 93.7%, and 89.2%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the CA 125 test were 60.8%, 83.3%, 88.2%, and 50.8%, respectively. The sensitivity and specificity of a combined evaluation of both CA 19-9 and CA 125 tests were 87.8% and 77.8%, respectively. CONCLUSIONS: Taking into account the high but still limited sensitivity and specificity of the CA 19-9 and CA 125 tests, their results in the differential diagnosis of pancreatic tumors should be interpreted consistently and in reference to imaging techniques such as ultrasonography and computed tomography.     

血清学肿瘤标志物与胰腺癌诊断及分期的关系

目的 探索血清学肿瘤标志物CA19-9、CEA及CA50与胰腺癌的早期诊断及分期的关系.方法 通过收集分析安徽医科大学附属省立医院普外科2013年1月-2015年10月收治入院的51例胰腺癌患者、10例胰腺良性肿瘤患者、12例慢性胰腺炎患者血清中CA19-9、CEA及CA50的测量值,比较它们在不同分期的胰腺癌及其他胰腺疾病中血清含量的不同.结果 CA19-9在不同分期胰腺癌及其他胰腺疾病中表达差异有统计学意义(P＜0.05).CEA及CA50在胰腺癌与胰腺其他疾病中表达差异具有统计学意义(P＜0.05).但CEA在Ⅰ期与Ⅱ期、Ⅰ期与Ⅲ期、Ⅱ期与Ⅲ期患者血清中的表达差异无统计学意义(P＞0.05).CA50在胰腺癌Ⅰ期与Ⅲ期、Ⅱ期和Ⅳ期中表达差异无统计学意义(P＞0.05).CA19-9诊断胰腺癌的阳性率高于CEA及CA50,CA19-9、CEA及CA50三者同时检测诊断胰腺癌的阳性率最高.结论 CA19-9、CEA及CA50在血清中的表达水平对于胰腺癌的早期诊断有一定的相关性,在胰腺癌分期中CA19-9的诊断价值最高.     

外周血K-ras基因突变和CA19-9的联合检测在胰腺癌诊断中的作用

目的 研究K-ras基因突变和CA19-9联合检测在胰腺癌诊断中的作用。方法 选择同期的15例胰腺癌和33非胰腺癌病人,同时行外周血K-ras基因突变和CA19-9的检测,利用统计学方法进行数据分析。结果 外周血K-ras基因突变和CA19-9联合检测诊断胰腺癌的敏感性、特异性分别为66．67％和97％,研究组和对照组之间差异具有显著性意义(P=0．001)。结论 外周血K-ras基因突变和CA19-9的联合检测显著提高了胰腺癌诊断的特异性,弥补了单一K-ras基因突变和CA19-9检测的不足,可用于胰腺癌的辅助诊断。     

P53蛋白和CA19-9对合并慢性胰腺炎的胰腺癌细胞学诊断的辅助作用

目的评估P53蛋白和CA19-9对合并慢性胰腺炎的胰腺癌与慢性胰腺炎的辅助鉴别诊断作用。方法24例疑有慢性胰腺炎背景的胰腺癌，病人经影像学诊断为胰腺内肿物，固相放免法检测血清CA19-9，剖腹探查术时胰腺穿刺，穿刺标本分为细胞学检查和P53蛋白检测两部分。结果细胞学诊断胰腺癌敏感性为63％，特异性为100％，准确性为63％；P53蛋白分析敏感性为44％，特异性为100％，准确性为73％；CA19-9敏感性为44％，特异性为80％，准确性为67％。联合检测细胞学与P53蛋白联合检测敏感性为78％，特异性为100％，准确性为92％；细胞学和CA19-9联合检测敏感性为67％，特异性为80％，准确性为67％；联合检测细胞学，P53和CA19-9敏感性78％，特异性为80％，准确性为79％。结论与单一标志物相比联合检测有助于有慢性胰腺炎背景的胰腺癌和慢性胰腺炎的鉴别诊断。细胞学和P53蛋白联合检测可提供最佳诊断方法。     

胰腺癌的诊断分析

目的探讨胰腺癌各种诊断方法的价值，以求进一步改善胰腺癌患者的预后。方法回顾分析1990年1月至2000年12月收治的321例胰腺癌患者的临床资料，统计患者的首发症状及各种检查方法的阳性例数。结果胰头癌、胰体尾癌和全胰癌最常见的首发症状为上腹痛(分别占55．6％、81．0％、87．5％)、腹胀不适(27．8％、39．2％、50．0％)。CA19-9的阳性率达到89．7％。影像学检查阳性率依次为核磁共振(92．0％)、血管造影(91．7％)、CT(84．3％)、B超(80．1％)、胃肠X线造影(46．7％)。结论上腹痛、腹胀不适为胰头癌、胰体尾癌和全胰癌最常见的首发症状；CA19-9可为胰腺癌的确诊提供有价值的线索；所有40岁以上有上腹痛及腹胀不适的患者均应行B超检查以排除胰腺癌；对临床上怀疑胰腺癌的患者应常规行CT检查。     

Tumour antigens CA 195 and CA 19-9 in pancreatic juice and serum for the diagnosis of pancreatic carcinoma.

OBJECTIVE--To see if tumour associated antigens CA 195 and CA 19-9 were able to differentiate between patients with pancreatic carcinoma, and those with chronic pancreatitis or stones in the common bile duct. DESIGN--Prospective, open, clinical study. SETTING--47 patients with histologically confirmed pancreatic adenocarcinoma, 38 with chronic pancreatitis diagnosed by endoscopic retrograde cholangiopancreatography (ERCP), and 26 with stones in the common bile duct diagnosed and treated by ERCP. INTERVENTIONS--Samples of serum taken from all patients just before ERCP, and samples of pancreatic juice obtained from 18, 11, and 12 patients, respectively during ERCP. RESULTS--Assay of the two tumour markers in pancreatic juice failed to differentiate between patients with benign and malignant disease. When assayed in serum, however, CA 195 detected those with carcinoma with a sensitivity of 72% and a specificity of 92%, and CA 19-9 with a sensitivity of 81% and a specificity of 88%. The patients with unresectable tumours had significantly higher concentrations of both markers in serum than patients with resectable tumours (p less than 0.05). CONCLUSIONS--CA 195 and CA 19-9 concentrations in serum are equally successful in differentiating between benign and malignant pancreatic disease. Assay of markers in pancreatic juice does not provide useful diagnostic information.     

The different manifestation and outcome between pancreatitis and pancreatic malignancy with left-sided portal hypertension.

Left-sided portal hypertension can be induced by isolated splenic venous obstruction due to various etiologies, such as chronic pancreatitis and pancreatic malignancy. The patients may present with bleeding isolated gastric varices and hypersplenism in addition to their pancreatic lesions. In the past 3 years, we have encountered 24 patients with left-sided portal hypertension. They were diagnosed with an abdominal echogram, CT or splenoportography. Twelve patients had histories of acute pancreatitis for a few months to years. Eleven of them were found to have isolated gastric varices. Six of them underwent operation due to hypersplenism or pseudocyst. The postoperative courses were smooth and the gastric varices subsided after splenectomy. The other 12 patients with left-sided portal hypertension were diagnosed as having pancreatic malignancy. Only two of them were found to have isolated gastric varices. Seven of them received operations and only two patients with their tumors located at the pancreatic body and tail could be resected. The other 5 patients were diagnosed with abdominal CT and high serum CA 19-9. We concluded that the patients with left-sided portal hypertension can be suspected by isolated gastric varices without liver cirrhosis. The diagnosis can be confirmed by abdominal CT or splenoportography. The incidence of isolated gastric varices are significantly lower in the patients with pancreatic malignancy than those with chronic pancreatitis. The gastric varices subsided after splenectomy. The prognosis of pancreatic malignancy is poor and most of them are inoperable.     

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??Clinical value of serum CA19-9 in the diagnosis of suspected pancreatic cancer by imaging methods WANG Wei-lin*, WU Ze-hui, ZHU Feng, et al. Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou310003, China
Corresponding author: ZHENG Shu-sen, E-mail:shusenzheng@zju.edu.cn
Abstract Objective To explore the clinical value of the combination of serum tumor marker CA19-9 and imaging methods (computed tomography and magnetic resonance imaging) in the diagnosis of pancreatic cancer. Methods The clinical data of 267 patients with suspected pancreatic cancer by imaging methods admitted from January 2010 to February 2012 in Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical School of Zhejiang University were analyzed retrospectively. Results In all 267 patients, 225 (83.0%) and 42 (17.0%) patients were diagnosed as pancreatic cancer and non-pancreatic cancer respectively. In the pancreatic cancer group, serum CA19-9 was elevated in 173 (76.9%) patients. Eighty-five patients with suspected pancreatic cancer by imaging methods had normal CA19-9 value. Among them, 52 (61.2%) patients were finally diagnosed as pancreatic cancer on pathology, and 33 (38.8%) patients as non-pancreatic cancer. One hundred and eighty-two patients with suspected pancreatic cancer by imaging methods had elevated CA19-9 value. Among them, 173 patients were finally diagnosed as pancreatic cancer on pathology and 9 patients as non-pancreatic cancer. Conclusion Serum tumor marker CA19-9 may provide valuable clues for the diagnosis of pancreatic cancer which is suspected by imaging methods. As to CA19-9 negative patients, in whom pancreatic cancer is suspected by imaging methods, much more attention should be paid to the possibility of false positive results of imaging methods. Pancreas puncture before surgery is recommended to confirm the diagnosis and exclude the possibility of chronic pancreatitis, pancreatic neuroendocrine tumors and solid-pseudopapillary tumor, etc. As to patients with elevated CA19-9 and imaging methods suspected pancreatic cancer, operation is recommended.     

血清ANGPTL2与胰腺癌临床病理特征的关系及其在胰腺癌诊断中的价值

背景与目的：胰腺癌临床起病隐匿,患者确诊时大多数已属晚期,失去了根治性治疗的机会。因此,寻找一种新的生物标志物用于胰腺癌的诊断具有重要意义。本研究探讨胰腺癌患者血清血管生成素样蛋白2（ANGPTL2）与病理特征的关系及其在胰腺癌诊断中的价值。 方法：比较125例胰腺癌患者和66例健康体检者血清ANGPTL2水平;用统计学方法分析胰腺癌患者血清ANGPTL2水平高低与临床病理参数、CA19-9水平的关系以及胰腺癌的危险因素;采用ROC曲线分析血清ANGPTL2、血清CA19-9以及两者联合检测对胰腺癌的诊断效能。 结果：胰腺癌患者血清平均ANGPTL2水平明显高于健康人群（6.52 ng/mL vs. 3.78 ng/mL,P<0.05）;胰腺癌患者血清ANGPTL2水平与肿瘤的大小、组织学分级、淋巴结转移和TNM分期密切有关（均P<0.05）,而与性别、年龄、远处转移无关（均P>0.05）;血清ANGPTL2水平与CA19-9水平呈明显正相关（r=0.772,P<0.001）;单因素分析和多因素分析显示,糖尿病（P=0.016）和ANGPTL2（P=0.014）是引起胰腺癌的独立危险因素;血清ANGPTL2、CA19-9及两者联合检测对胰腺癌诊断的AUC分别为0.939、0.953、0.966,特异度与阳性预测值分别为92.4%与95.7%、84.8%与91.9%、98.5%与96.4%。 结论：胰腺癌患者血清ANGPTL2水平升高,其表达与临床病理特征密切相关;ANGPTL2与CA19-9联合检测对胰腺癌的诊断具有一定价值。     

六种血清肿瘤标志物在胰腺癌临床诊断中的意义

目的：评价血清肿瘤标志物检测对胰腺癌的诊断及胰腺良恶性疾病的鉴别诊断的价值。方法：回顾性分析191例患者血清中CA19-9、CA242、CA125、CA50、癌胚抗原（CEA）及甲胎蛋白（AFP）水平,将胰腺癌与肝脏恶性肿瘤、胃肠道恶性肿瘤、胆道恶性肿瘤及其他良性疾病进行对比,分析其临床价值;同时与胰腺良性占位进行比较,分析肿瘤标志物在已明确的胰腺占位性病变中的鉴别诊断价值。绘制各肿瘤标志物的ROC曲线,计算曲线下面积（AUC）并进行分析处理。结果：6种肿瘤标志物中,CA19-9、CA50和CA242水平在胰腺癌组均高于胰腺良性疾病组、肝脏恶性肿瘤组、胃肠道恶性肿瘤组和其他良性疾病组,差异有统计学意义（P〈0.05）。胰腺癌组CA125、CEA水平亦高于胰腺良性疾病组（P〈0.05）。CA19-9的敏感性为79.49%,阴性似然比为0.28,其AUC为0.925。结论：CA19-9、CA50和CA242对胰腺与非胰腺疾病鉴别有意义;CA19-9对胰腺肿瘤良恶性鉴别的综合诊断能力较其他肿瘤标志物强,对胰腺恶性肿瘤与胆道恶性肿瘤鉴别能力较差。     

CT,ERCP,CA19-9对有慢性胰腺炎背景的胰腺癌与慢性胰腺炎鉴别诊断的局限性

目的目前CA19-9，CT和ERCP被认为是诊断胰腺疾病的常规检查手段。然而仍存在有慢性胰腺炎背景的胰腺癌与慢性胰腺炎鉴别诊断的误诊问题。认识常规检查手段的局限性对提高两种疾病的诊断十分必要。方法我们回顾分析了过去6年间因高度怀疑胰腺癌接受胰腺切除术的24例病人包括CA19-9的化验检查，CT，ERCP病史资料。最终诊断依据组织学。结果最终诊断结果有慢性胰腺炎背景的胰腺癌9例，类似肿瘤性胰腺炎13例，胰腺腺瘤合并慢性胰腺炎2例。临床资料，化验检查无鉴别诊断意义。CA19-9＞37U／ml胰腺癌4例，慢性胰腺炎3例；两种疾病的CT。ERCP影像学相似。结论CA19-9，CT，和ERCP对有慢性胰腺炎背景的胰腺癌诊断价值有限。为明确诊断进一步发掘其它的特异性检查手段。     

Needle biopsy for suspicious lesions of the head of the pancreas: Pitfalls and implications for therapy

Controversy continues to exist concerning the optimal diagnostic approach to a pancreatic head lesion suspected of being a neoplasm. The objective of this study was to evaluate the impact of needle biopsy in suspicious pancreatic head neoplasia and its effect on therapy and outcome. Seventy-three patients with symptoms or signs of periampullary neoplasia and a pancreatic head lesion identified on CT scan were reviewed retrospectively. Forty patients with potentially resectable lesions underwent intraoperative transduodenal core needle biopsy of the head of the pancreas. Thirty-three patients underwent CT-guided percutaneous fine-needle aspiration. The sensitivity and specificity of core needle biopsy were 76% and 100%, respectively. One death was directly related to the procedure and therapy was adversely affected in one patient with a false negative result. The sensitivity and specificity of percutaneous fine-needle aspiration were 85% and 92%, respectively, and were not significantly different from the core needle biopsy results (P>0.3). Three false negative fine-needle aspiration biopsies occurred in patients with potentially resectable lesions and a low clinical suspicion for malignancy. In patients with a mass in the head of the pancreas on CT scan, fine-needle aspiration biopsy offers results similar to those of intraoperative transduodenal core needle biopsy. In patients estimated to have resectable disease, a pancreaticoduodenectomy should be performed without a biopsy. For patients with unresectable disease, cytologic examination of fine-needle aspirate should be performed. If this examination is positive, it offers the advantage of facilitating the construction of a rational plan for palliation.     

CT引导下细针穿刺早期诊断急性坏死性胰腺炎继发感染

目的 探讨应用ＣＴ引导下细针穿刺（ＦＮＡ）早期诊断急性坏死性胰腺炎继发感染的方法。;方法 对１４例临床怀疑有继发感染的急性坏死性胰腺炎患者行ＣＴ引导下ＦＮＡ。抽吸物行涂片革兰染色、细菌培养以及聚合酶链反应（ＰＣＲ）细菌检测。结果 １０例最终诊断为胰腺感染,４例最终诊断为胰腺未感染,共行ＦＮＡ１５例次,其中,１２例次经左侧腹膜后穿刺,１例次同时行左侧和右侧腹膜后穿刺,２例次经腹腔穿刺,与最终诊断结果比较,ＦＮＡ抽吸物涂片、ＰＣＲ、培养诊断胰腺感染的敏感性分别为７／１０、９／１０、１０／１０,特异性均为４／４,需要时间分别为３０ｍｉｎ、４ｈ、３ｄ。结论 对多数急性坏死性胰腺炎患者可选择腹膜后路径行ＣＴ引导下ＦＮＡ,以避开胃肠和重要脏器;抽吸物ＰＣＲ诊断胰腺感染,快速准确,适应临床快速诊断胰腺感染的要求。     

Preoperative diagnostics in pancreatic carcinoma: would less be better?

Objective: The objective of this study was to investigate the value of preoperative diagnostics in patients with pancreatic carcinoma in terms of tumor diagnosis and evaluation of resectability. Patients/Methods: From 1 September 1985 to 31 December 1997, 408 patients shown by histology to have a ductal (n=330) or periampullary carcinoma (n=78) were treated at our hospital. Results: In determining the presence of tumor, ultrasonography and computed tomography (CT) had a sensitivity of 88.3% and 94.0%, respectively; combined, they had a sensitivity of 96.2%. Endoscopic retrograde cholangiopancreatography (ERCP) had a sensitivity of 96.2%. Preoperative aspiration biopsy cytology had a sensitivity of 71.4%. No correlation was found in the patients undergoing surgery between the preoperative level of serum CA 19-9 and the presence of distant metastases. Tumor infiltration of the portal vein was shown with a sensitivity of 33.3%, 24.3%, and 76.5% and a specificity of 93.9%, 98.9%, and 65.6% by ultrasonography, CT, and angiography, respectively. Ultrasonography and CT detected liver metastases or peritoneal carcinomatosis with a sensitivity of 35.9% each and a specificity of 91.9% and 91.7%, respectively. Conclusion: This study shows that, in 96% of patients with pancreatic carcinoma, ultrasonography and CT are adequate for diagnosis and for the evaluation of resectability. ERCP is not the method of choice in the diagnosis of pancreatic carcinoma due to its invasiveness and to the fact that it fails to demonstrate the pathological anatomical location of the tumor; it should only be used if a tumor is suspected despite negative results on ultrasonography and CT or as an additional diagnostic method to differentiate between chronic pancreatitis and carcinoma. On account of the low sensitivity of percutaneous aspiration biopsy cytology, this method is not necessary preoperatively and may even lead to the spread of tumor cells. In 7% of patients, routine laparoscopy would additionally show liver metastases or peritoneal carcinomatosis not demonstrated using the imaging techniques. Received: 27 December 1997