超声引导门静脉瘤栓活检与无水乙醇经门静脉、肝动脉注射治疗肝癌

目的探讨超声引导细针抽吸活检对门静脉癌栓(PVTT)的鉴别诊断价值及超声介入门静脉联合肝动脉注射无水乙醇(PEI)对PVTT的治疗效果.方法对23例原发性肝细胞癌(HCC)伴发门静脉栓子(PVT)及16例肝硬化伴发PVT在超声引导下行细针穿刺抽吸活检,并对其中16例门静脉分支充满型栓子行18 G自动组织活检.比较细针抽吸活检细胞学、组织学与自动活检的阳性率.确诊的PVTT 35例,其中行单纯门静脉穿刺PEI治疗PVTT 19例(A组),行门静脉、肝动脉联合PEI(双介入)治疗PVTT 16例(B组).全部病例同时行肝内肿瘤结节PEI治疗.对比观察A、B两组治疗后PVTT消失与缩小率、甲胎蛋白(AFP)下降率与1～3年生存率.结果细针抽吸活检细胞学、组织学阳性率分别为89.7%(35/39)和87.2%(34/39),与同部位自动活检阳性率93.8%(15/16)比较无显著性差异(P＞0.05).23例HCC伴PVT抽吸活检中21例诊断为癌栓,余2例为血栓.16例肝硬化伴发PVT活检均未发现肝癌细胞和(或)组织.35例PVTT治疗后B组的癌栓缩小消失率与停止发展率以及总有效率分别为50.0%、37.5%与87.5%,均较A组的36.8%、36.8%与73.6%为高,但无显著性差异(P＞0.05);B组AFP降为正常者高达76.9%(10/13),明显高于A组的37.5%(6/16)(P＜0.05);B组1、2、3年生存率分别为87.5%(14/16)、64.3%(9/14)与44.4%(4/9),均明显高于A组的52.6%(11/19)、27.3%(3/11)与0%(均P＜0.05).结论本研究表明超声引导细针穿刺活检及超声双介入PEI对PVTT早期明确诊断与提高疗效有一定的临床应用价值.     

术前超声内镜引导下细针穿刺对可切除胰腺癌诊断之安全性和准确性的探讨*

目的探讨术前超声内镜引导下细针穿刺(EUS-FNA)对可切除胰腺癌患者诊断之安全性及准确性。方法回顾性分析该院2010年1月-2014年12月256例胰腺癌患者的临床资料,其中82例有手术切除的指征:54例术前行EUS-FNA术(FNA+组)和28例无术前EUS-FNA(FNA-组),观察EUS-FNA的诊断情况及两组患者的生存时间。结果 FNA+组54患者EUS均见肿瘤病灶,所有患者FNA均成功。根据细胞学和组织学,EUS-FNA诊断的准确性分别为94.44%(51/54)和88.89%(48/54),总准确率为94.44%(51/54)。2例EUS-FNA后出现轻度胰腺炎,2例并发出血,经保守治疗后痊愈,无其他严重并发症。在FNA+和FNA-组的中位无复发存活时间分别为282和265 d(P0.05),平均总生存时间分别为568和557 d(P0.05)。FNA+组的RFS和OS并不逊色于FNA-组。这些数据表明,EUS-FNA并不影响中位无复发存活期或总生存期,也没有增加其他并发症的风险。结论术前EUS-FNA对可切除胰腺癌患者是一种安全、准确的诊断方法。     

Occult hepatocellular carcinoma in cirrhosis: Value of ultrasound-guided biopsy of portal vein system thrombus

We report two cases of occult hepatocellular carcinoma associated with alcoholic cirrhosis, in which the diagnosis of malignancy was respectively established by ultrasound-guided biopsy of umbilical vein and portal vein branch thrombus. When measurement of serum alpha-foetoprotein, and liver ultrasonography and/or computed tomography failed to clearly demonstrate hepatocellular carcinoma, the presence of a thrombosis of the portal vein system is highly suggestive of malignancy, which may be easily confirmed by venous biopsy.     

Endoscopic ultrasonography/fine-needle aspiration and endobronchial ultrasonography/fine-needle aspiration for lung cancer staging

This article reviews different techniques available for diagnosis and staging of patients with non-small cell lung cancer (NSCLC). The advantages and disadvantages of each staging method are highlighted. The role of the gastroenterologist in NSCLC staging is explored. A new algorithm is proposed for the staging of NSCLC that incorporates endoscopic and endobronchial ultrasonography for mediastinal staging in patients with intrathoracic disease.     

Ureteral metastasis from an appendiceal carcinoma and diagnosis by endoscopic ultrasound-guided fine-needle aspiration

Endoscopic ultrasound (EUS) is a standard tool for imaging the gastrointestinal tract and adjacent structures. EUS-guided fine-needle aspiration (FNA) allows the endosonographer easy access to these structures for both diagnostic and therapeutic purposes. We describe a case of metastatic lesion, adherent to a stented right ureter, which was imaged with transrectal EUS, with successful cytologic identification after EUS-guided FNA. EUS and EUS-guided FNA can be valuable tools in the evaluation of some soft-tissue abnormalities of the pelvis.     

Endoscopic ultrasound-guided fine-needle aspiration biopsy for lymphadenopathy of unknown origin

BACKGROUND AND STUDY AIMS: The diagnosis of mediastinal and intra-abdominal lymphadenopathy is sometimes difficult, especially in patients who have no other primary lesions. Lymphoma is one of the main causes of this condition. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe and accurate diagnostic procedure for lesions surrounding the gastrointestinal tract. However, diagnosing lymphoma using the EUS-FNA technique remains a diagnostic challenge, due to limitations in the amount of material sampled. The aim of the present study was to evaluate the yield of EUS-FNA biopsy (EUS-FNAB) using a large-gauge needle in patients with mediastinal and intra-abdominal lymphadenopathy of unknown origin, especially in relation to subclassification of the lymphomas. PATIENTS AND METHODS: Consecutive patients with mediastinal and intra-abdominal lymphadenopathy of unknown origin who were referred between October 2003 and March 2005 were enrolled in the study. EUS-FNAB was carried out using a 19-gauge needle, passing through the esophageal, gastric, and duodenal walls. Pathological diagnoses were made on the basis of histological findings, including immunopathological staining. RESULTS: A total of 104 patients were included in the study. The locations of the lymph nodes were mediastinal in 50 patients, intra-abdominal in 48 patients, and both mediastinal and intra-abdominal in six patients. The diagnoses made using EUS-FNAB were lymphoma (n = 48), metastasis (n = 16), and benign/reactive (n = 40). The overall accuracy of EUS-FNAB for unknown lymphadenopathy was 98 %, and it was possible to classify the lymphomas in accordance with the World Health Organization classifications in 88 % of cases. No serious complications occurred with the procedure. CONCLUSIONS: Open thoracic surgery, laparotomy, and other invasive diagnostic procedures such as mediastinoscopy and laparoscopy can now be avoided, as EUS-FNAB is potentially a safe and accurate tool for diagnosing unknown lymphadenopathy, including lymphoma.     

Percutaneous transheptic cholangioscopic ethanol injection for intrabiliary tumor thrombi due to hepatocellular carcinoma

Interventional treatments such as transcatheter arterial embolization and placement of a biliary endoprosthesis have been carried out in cases of inoperable hepatobiliary malignancy. We report here a case of recurrent intrabiliary tumor thrombi due to hepatocellular carcinoma, successfully treated by cholangioscopic ethanol injection in which the intrabiliary tumor thrombi were completely eliminated.     

超声引导细针抽吸活检对门静脉癌栓的鉴别诊断价值

目的　探讨超声引导细针抽吸活检对门静脉癌栓 (PVTT)的鉴别诊断价值。方法　对 2 2例原发性肝细胞癌 (HCC)伴发门静脉栓子 (PVT )及 8例肝硬化伴发PVT在超声引导下行细针穿刺抽吸活检 ,并对其中 8例门静脉分支充满型栓子行 18G自动组织切割活检。计算细针抽吸细胞学、组织学的阳性率并与自动活检阳性率进行比较。结果　细针抽吸活检细胞学、组织学阳性率分别为 93 .3 % ( 2 8/3 0 )和90 .0 % ( 2 7/3 0 ) ,与同部位自动活检阳性率 91.7% ( 11/12 )比较差异无显著性意义 ( P >0 .0 5 )。 2 2例HCC伴PVT抽吸活检肝细胞癌阳性 17例 ( 77.3 % ) ,组织学阳性 18例 ( 81.8% ) ,综合后 2 0例诊断为癌栓 ,余 2例为血栓。 8例肝硬化伴发PVT活检均未发现肝癌细胞和 (或 )组织。结论　超声引导门静脉栓子细针抽吸活检有较高的阳性率与诊断价值 ,且与自动活检阳性率无明显差异 ,因此对于彩色多普勒血流显像与脉冲多普勒诊断尚不明确的病例采用细针抽吸活检可达到早期明确诊断的目的。     

超声引导穿刺活检DNA分析对肝癌疗效判断的价值

目的 探讨超声引导穿刺活检DNA分析对肝癌疗效判断的价值。方法 肝癌患者22例,肝内良性增生结节6例,采用超声引导穿刺活检技术,对肝癌患者在超声介入治疗前后和肝内良性增生结节行病理活检的同时,将活检新鲜组织制成单细胞悬液应用流式细胞术（FCM）行DNA检测及细胞周期比值分析,观察细胞增殖比值,以及是否出现DNA的异倍体峰、凋亡细胞峰及其百分比。结果 22例肝癌组织经FCM检测,5例（22．7％）出现异倍体峰;6例肝内良性增生组织均未出现异倍体。肝癌组织的S期与G2／M期比率均显著高于良性增生结节（P＜0．01）。22例肝癌经超声介入治疗后DNA分析显示G1期比率上升,S期与G2／M期比率下降（P＜0．01）,治疗后5例异倍体峰消失,并有12例（54．5％）出现凋亡细胞峰。结论 采用超声引导穿刺活检,不仅可提供病理形态学信息,还可将抽吸的组织应用FCM进行DNA分析,为肿瘤疗效判断与预后提供有效的生物学判断依据。     

Endoscopic ultrasound-guided fine-needle aspiration cytology for diagnosis above and below the diaphragm

Endosonography ultrasound (EUS) is a minimally invasive technology using a high-frequency ultrasound transducer that is incorporated into the tip of a conventional endoscope. This technique permits high-resolution imaging of the gastrointestinal wall and structures in its vicinity, as well as real-time endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA). This is a review of the literature on EUS-guided FNA of the mediastinal and abdominal lymph nodes, the pancreas, intramural gastrointestinal masses, and other miscellaneous organs and body cavities. EUS-guided FNA is a recently developed procedure that has established itself as a safe, highly accurate, and clinically useful modality.     

肝癌合并门静脉癌栓患者肝内缸流变化

目的 研究原发性肝癌合并门静脉癌栓时门静脉和肝动脉的超声表现和血流动力变化。方法 应用超声分别研究肝癌合并门静脉癌栓组（癌栓组）和对照组门静脉、肝动脉的二维和多普勒超声改变及血流动力学各项指标。结果 癌栓组较对照组门静脉内径明显增高，流速降低（P〈0.05），肝动脉显示率和流速明显提高（P〈0.05）。结论应用彩超检查获得肝癌合并门静脉癌栓肝内血流的重要指标，对诊断、指导治疗和判断预后有重要意义。     

Early diagnosis of hepatocellular carcinoma: usefulness of ultrasonically guided fine-needle aspiration biopsy

The results of various diagnostic procedures performed on six cases with solitary and minimal (less than 2 cm) hepatocellular carcinoma (HCC) that was later surgically resected were comparatively reviewed. The tumor was detected in 6/6 patients by ultrasonography, 1/6 by scintigraphy, 2/6 by CT, and 4/6 by angiography, and hepatocellular carcinoma was diagnosed in 3/6 by angiography and 6/6 by ultrasonically guided fine-needle aspiration biopsy. Since there are not a few HCCs that can be detected only by ultrasonography, fine-needle aspiration biopsy with ultrasound guidance is strongly recommended to confirm cases with a minimal lesion in the liver visualized only on a sonogram.     

甲状腺结节超声引导细针穿刺初学者质量控制方法探讨

目的通过分析超声科6名医师甲状腺结节超声引导下细针穿刺活组织检查（US-FNAB）的学习曲线,探讨US-FNAB初学者达到平均水平且相对稳定时所需的训练量,从而指导科室有效管控初学者甲状腺结节US-FNAB的穿刺质量。 方法选取2011年3月至2014年11月四川大学华西医院超声科6名穿刺医师（Dr1~Dr6）行US-FNAB的甲状腺结节6147例（其中Dr1和Dr6为有经验穿刺医师;Dr2~Dr5为穿刺初学者）,收集其细胞病理学结果。并按结节的穿刺时间排序,从第1例结节开始,每100例为一组,依次进行分组。根据Bethesda分类标准将结节细胞病理学结果分为穿刺无效和穿刺有效2类,统计每一位医师每一组的穿刺无效率,绘制学习曲线。统计6名医师6147例甲状腺结节穿刺无效率的平均值。按照甲状腺结节的穿刺时间排序,统计Dr2~Dr5每名初学者第一个100例（F100）和第二个100例（S100）的穿刺无效率。采用四格表的χ²检验,将Dr2~Dr5每名初学者的F100和S100的穿刺无效率分别与6147例甲状腺结节穿刺无效率的平均值进行比较。 结果Dr1~Dr6每名医师每组穿刺无效率分别为：Dr1（17组）：25%、23%、17%、17%、14%、15%、24%、14%、12%、7%、8%、9%、6%、10%、11%、16%、8%;Dr2（5组）：40%、27%、24%、21%、13%;Dr3（10组）：22%、9%、20%、23%、13%、17%、14%、11%、10%、15%;Dr4（15组）：21%、22%、28%、26%、22%、29%、24%、19%、14%、20%、8%、11%、11%、9%、4%;Dr5（8组）：39%、24%、13%、21%、12%、13%、8%、9%;Dr6（4组）：13%、15%、5%、9%。由此绘制学习曲线。6名医师6147例甲状腺结节穿刺无效率的平均值为16.04%。Dr2~Dr5每名初学者F100和S100的穿刺无效率分别为：Dr2：40%,27%;Dr3：22%,9%;Dr4：21%,22%;Dr5：39%,24%。Dr2~Dr5每名初学者F100穿刺无效率和平均值的比较,差异有统计学意义的为Dr2（χ²=14.286,P<0.001）和Dr5（χ²=13.266,P<0.001）,S100穿刺无效率和平均值的比较中,差异均无统计学意义（P均>0.05）。 结论绘制甲状腺结节US-FNAB初学者学习曲线,探讨其学习曲线规律,分析其达到平均穿刺水平且相对稳定时的训练量,从而准确判断初学者能够独立操作的时机,是初学者甲状腺结节US-FNAB质量控制的有效方法。     

Iatrogenic candidal infection of a mediastinal foregut cyst following endoscopic ultrasound-guided fine-needle aspiration

EUS-guided fine-needle aspiration (EUS-FNA) is a safe procedure with few complications. We describe the introduction of Candida into a mediastinal foregut cyst following trans-oesophageal EUS-FNA, and discuss the implications of this complication.