内镜诊断胰腺囊性肿瘤的临床价值

目的探讨内镜对胰腺囊性肿瘤的诊断效果。方法 76例胰腺囊性肿瘤患者在彩色多普勒超声仪引导下分别使用内镜检测、单独进行CT检查和多普勒超声检查,并对比这3种检查方法的检测结果,评价3种方法的检测准确性。结果所有患者中有29例浆液性囊腺瘤,47例黏液性囊性肿瘤。52例患者的病变部位位于胰头颈部,24例位于胰体尾部。在彩色多普勒超声下内镜检测胰腺囊性肿瘤的准确率可以达到89.5%,CT检测和单独多普勒超声检测的准确率分别为55.3%和44.7%。使用内镜检测与CT检测和单独多普勒超声检测相比,检出准确率差异均有统计学意义(P<0.05)。内镜检测浆液性、黏液性胰腺囊性肿瘤及胰头颈部和胰体尾部均比CT检测和单独多普勒超声检测具有更高的检出准确率。CT和单独超声检测对胰体尾部囊性肿瘤检测准确率比胰头颈部的准确率高,差异具有统计学意义(P<0.05),而内镜检测胰体尾部囊性肿瘤检测准确率比胰头颈部的准确率高。结论内镜检测胰腺囊性肿瘤比CT和多普勒超声检查具有更高的准确率。     

胰腺转移性肿瘤的超声诊断

复习１８例经病理学、细胞学或诊断性治疗证实的胰腺转移瘤病人的超声诊断。在声像图上，肿瘤通常表现为低回声，后方回声无变化或增强，边界较清楚但不规则，胰头病灶可导致胆总管和胰管的扩张；邻近血管受压、显示不清或消失，或肿物与血管的分界不清。胰腺转移瘤虽然较为少见，但早期发现较难。在与原发性胰腺癌进行鉴别时，应结合病人原发肿瘤的存在，肿块边界清楚，行超声引导针吸活检，从而作出正确的诊断。     

超声内镜与多层螺旋CT诊断胰腺神经内分泌肿瘤的价值

目的:探讨超声内镜(EUS)与多层螺旋CT(MSCT)诊断胰腺神经内分泌肿瘤(pNENs)的价值.方法:回顾性分析2012年至2016年43例均行EUS和MSCT检查并经组织病理学确诊为pNENs患者的临床、影像和病理资料,比较EUS和MSCT对pNENs的检出率和敏感性,并分析EUS和MSCT在肿瘤最大径≥2 cm或<2 cm、功能性或无功能性pNENs诊断中是否存在差异.结果:43例经组织病理学确诊的pNENs中,男23例、女20例,年龄(57.2±13.6)岁(28~75岁),肿瘤最大径(2.6±2.1) cm(0.6~7.3 cm),其中19例≥2 cm、24例<2 cm,功能性pNENs 26例、非功能性pNENs 17例.总体而言,EUS和MSCT检出率分别为90.7%(39/43)和69.8%(30/43),差异具有统计学意义(P=0.015);EUS和MSCT敏感性分别为71.8%(28/39)和73.3%(22/30),差异无统计学意义(P=0.887).按肿瘤最大径不同比较:EUS和MSCT对肿瘤最大径≥2 cm pNENs的检出率分别为100%(19/19)和100%(19/19),差异无统计学意义(P=1.000);敏感性分别为73.7%(14/19)和78.9%(15/19),差异无统计学意义(P=0.703).EUS和MSCT对肿瘤最大径<2 cm pNENs的检出率分别为83.3%(20/24)和45.8%(11/24),差异具有统计学意义(P=0.007);敏感性分别为70.0%(14/20)和63.6%(7/11),差异无统计学意义(P=0.717).按肿瘤有无功能比较:EUS和MSCT对功能性pNENs的检出率分别为88.5%(23/26)和53.8%(14/26),差异有统计学意义(P=0.006);敏感性分别为73.9%(17/23)和64.3%(9/14),差异无统计学意义(P=0.534).EUS和MSCT对非功能性pNENs的检出率分别为94.1%(16/17)和94.1%(16/17),差异无统计学意义(P=1.000);敏感性分别为68.8%(11/16)和81.3%(13/16),差异无统计学意义(P=0.414).结论:MSCT对直径≥2 cm 的pNENs检出率和敏感性较好,但对直径<2 cm的pNENs检出率和敏感性较低,有必要联合EUS检查.     

超声造影联合彩色多普勒超声对胰腺肿瘤的诊断价值

目的 探讨超声造影联合彩色多普勒超声对胰腺肿瘤的诊断价值.方法 选取了65例胰腺肿瘤患者,按肿瘤类型分为两组,恶性组(42例)和良性组(23例),均采用彩色多普勒超声造影进行检查,观察记录彩色多普勒超声造影诊断胰腺良恶性肿瘤的时相变化、超声表现及造影增强表现.结果 恶性组开始增强时间明显晚于良性组(p＜0.05),恶性组开始减退时间,造影剂渡越时间均明显短于良性组(P＜0.05),两组到达峰值时间相比,无明显统计学差异(P＞0.05).胰腺良性和恶性肿瘤在超声表现上具有明显差异.恶性组造影部分增强表现例数明显多于良性组(P＜0.05),两组在全部增强、囊实性的实性部分增强、无增强例数上相比,差异没有统计学意义(P＞0.05).结论 彩色多普勒超声造影能明显区分鉴别胰腺良恶性肿瘤,具有良好的诊断能力,值得临床推广使用.     

超声评估胰腺肿瘤的价值

目的 胰腺肿块的鉴定和疾病范围的超声评估和可切除性预测的研究。方法 SSA-270A型彩超显像仪,胰腺标准切面为横切、纵切和斜切。同时评估肝、胆道、门静脉和后腹腔血管结构。结果 本组病人超声检出率分别为胰腺肿块98.5％,淋巴结71.4％,肝转移100％,胆道梗阻86.2％,血管受侵58.3％,可切除性预测准确率为38.5％。结论 超声在胰腺肿块的鉴定和疾病范围评估方面是非常有用的,对胰腺肿块不可切除性的预测方面有较好的效果,但对可切除疾病预测方面则因不 能准确检出血管受侵而呈低敏感性。     

B型超声对胰腺区肿瘤的诊断价值

回顾性分析了经手术、病理(包括细针穿刺细胞学检查)证实的44例胰腺区肿瘤B超声像图。超声诊断定位正确者42/44(95.5％),显示病变者37/44(84％);定性诊断正确者32/44(72.7％),其中胰头癌19/22(86.4％)、胰体尾癌3/4(75％),全胰腺癌2/2(100％)、壶腹癌8/14(57.1％)。文中详述了本组病例的声像图特点,分析了B超对胰腺区肿瘤误诊的原因,并对如何提高超声检查胰腺区病变的显示率,以及其临床价值进行了讨论。     

消化系统肿瘤超声内镜诊断进展

超声内镜（EndoscopicUltrasonography,EUS）是近十年来开发的一项新技术。自1980年的Strohm和Dimagno等首次报道将EUS应用于诊断消化道疾病以来,已在世界各地得到广泛的应用。尤其是EUS器械的改进和发展,为消化道疾病的诊断开辟了新的途径。近年来,EUS在消化系肿瘤的应用得到了重视,取得了重大进展。现将有关资料综述如下：l食管癌的诊断食管是最早开展腔内超声检查的器官。研究证实,超声内境在食管癌的术前局部分期中有较高的准确性,优于呼和MRI等其它方法。许国铭等［‘j研究认为,EUS能正确反映粘膜下肿瘤起源,癌肿侵犯…     

肿瘤标志物在胰腺占位中的鉴别诊断价值

0引言 CA19-9等对胰腺癌诊断的研究颇多,但对于胰腺良恶性占位研究至今较少.而精确判断胰腺占位的良恶性仍是临床工作的难点之一,不仅对于胰腺癌要尽可能尽早手术治疗,对于一些低度恶性占位比如胰腺浆液性囊腺瘤等亦要首选手术治疗,故精确区分炎症性占位及恶性占位不仅有利于治疗方案的选择,尤其对于恶性占位选择及早手术至关重要,深入研究血清诊断良恶性占位具有重要临床应用价值.     

肿瘤诊断 内镜助力

消化道内镜的发明给消化道疾病的诊治带来了革命性的改变,内镜可以在创伤很小的情况下直视消化道内部,可以同时获取组织学标本,甚至可在内镜下进行治疗。消化道肿瘤的检查主要应用以下几种内镜:胃镜:经口进入,患者在检查前早晨空腹,不用做肠道准备。胃镜可以观察食管、胃、十二指肠直至近段的空肠。主要观察消化道的内     

超声造影在胰腺肿瘤诊断中的应用

超声造影可以增强低速血流的显示,提供胰腺肿瘤的血流灌注特征.大部分胰腺导管腺癌表现为低增强,而内分泌肿瘤多表现为高增强,肿块形成型胰腺炎多表现为等增强.超声造影能够提高超声对胰腺肿瘤的诊断和鉴别诊断能力,有较高的临床应用价值.     

超声内镜技术在胰腺癌诊断和治疗中的应用价值

胰腺癌恶性程度极高,其诊断和治疗一直是临床工作的难点。螺旋CT、磁共振成像（magnetic resonance imaging,MRI）和超声内镜（endoscopic ultrasound,EUS）是诊断胰腺癌的重要工具。随着EUS技术的不断完善,其在胰腺癌诊断中的作用和价值逐渐得到体现,特别是EUS引导下细针穿刺（EUS-guided fine needle aspiration,EUS-FNA),是目前获取胰腺病理的重要手段。此外,EUS在胰腺癌治疗中的地位也日益突出,EUS弹性成像（EUS elastography,EUS-EG）及造影增强EUS（contrast-enhanced EUS,CE-EUS）可以指导内科用药,EUS引导下的局部治疗也是胰腺癌综合治疗的重要组成部分。因此,该文回顾和评估了EUS技术在胰腺癌诊断和治疗中的价值,为EUS在胰腺癌中的应用提供参考。     

Proliferative rate in endoscopic ultrasound fine‐needle aspiration of pancreatic endocrine tumors

BACKGROUND:

The objectives of this study were to evaluate the role of endoscopic ultrasonography (EUS)‐guided fine‐needle aspiration (FNA) in the preoperative diagnosis of pancreatic endocrine tumors (PETs) and to investigate whether the Ki‐67 index determined on cytologic material could help predict their behavior.

METHODS:

The study included 10 men and 5 women (ratio of men to women, 2:1) with a mean age of 62.4 years (range, 40‐79 years). Diff‐Quik‐ and Papanicolaou‐stained FNA samples were analyzed retrospectively, and immunocytochemical stains were performed for chromogranin A, synaptophysin, vimentin, α‐1‐antitrypsin, and Ki‐67 on cell block sections. The Ki‐67 index was evaluated by using digital image‐analysis software and was correlated with follow‐up (mean, 21.5 months; range, 2‐43 months).

RESULTS:

The overall survival was rate 86.7% (13 of 15 patients). Seven of 15 patients (46.7%) patients developed lymph node and/or hematogenous metastases. The Ki‐67 index in PETs with no metastases was lower (mean, 6.3%; range, 2%‐13%) than in clinically aggressive (metastatic) tumors (mean, 7.7%; range, 3%‐27%; P = .03). None of the tumors that had a Ki‐67 index ≤2% were metastatic. Both patients who died of disease had a Ki‐67 index of 4%.

CONCLUSIONS:

Although tumors with metastatic potential tended to exhibit a slightly higher Ki‐67 index, there was a significant overlap with nonmetastatic tumors, and PETs that had a very low proliferative rate still could behave aggressively; therefore, the authors concluded that the Ki‐67 index does not predict the risk of disease progression in patients with PETs. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.     

高强度聚焦超声治疗晚期胰腺癌的临床观察

目的 探讨高强度聚焦超声（HIFU）治疗晚期胰腺癌的疗效和安全性。方法 对41 例晚期胰腺癌患者行HIFU 治疗,观察治疗前后的影像学变化及临床症状,评价HIFU 治疗的近期有效率（RR）、临床受益率（CBR）、生存期及不良反应。结果 全组RR 为29.3%, CBR 85.4%,中位生存期6.7 个月（3.5～10.8 个月）,未发生皮肤烧伤、胰腺炎、胃肠道损伤等并发症。结论 HIFU 是一种治疗胰腺癌的有效方法,具有无创和较高的安全性,应用范围广,适合病情较重、不能耐受其他方法治疗的患者。     

超声检查对小肠间质瘤的诊断价值

目的探讨超声检查对小肠间质瘤的临床诊断价值。方法对福建省肿瘤医院2008年4月至2015年5月收治且经手术及病理证实的39例小肠间质瘤患者的超声资料进行回顾性分析。结果按病理危险分级标准将39例患者分为极低危组(1例)、低危组(11例)、中等危组(1例)、高危组(26例)。超声诊断符合率为64.1%(25/39),漏诊2例(5.1%)。低危组病灶超声表现均呈边界清楚的低回声团块,多呈类圆形,内部回声均匀,团块内部多见Ⅰ级血流信号(63.6%,7/11);高危组病灶呈囊实性和低回声,团块多数边界清楚,但内部回声不均,46.2%呈分叶状,团块内部多见Ⅱ~Ⅲ级血流信号(61.5%,16/26)。结论超声作为临床应用最广的检查项目之一,对小肠间质瘤的术前筛查具有重要价值,结合临床表现有助于提高其诊断率。     

Role of endoscopic ultrasound in anticancer therapy: Current evidence and future perspectives

The digestive system is one of the most common sites of malignancies in humans. Since gastrointestinal tumors represent a massive global health burden both in terms of morbidity and health care expenditures, scientists continuously develop novel diagnostic and therapeutic methods to ameliorate the detrimental effects of this group of diseases. Apart from the well-established role of the endoscopic ultrasound (EUS) in the diagnostic course of gastrointestinal and hepatobiliary malignancies, we have recently become acquainted with a vast array of its therapeutic possibilities. A multitude of previously established, evidence-based methods that might now be guided by the EUS emerged: Radiofrequency ablation, brachytherapy, fine needle injection, celiac plexus neurolysis, and endoscopic submucosal dissection. In this review we endeavored to provide a comprehensive overview of the role of these methods in different malignancies of the digestive system, primarily in the treatment and symptom control in pancreatic cancer, and additionally in the management of hepatic, gastrointestinal tumors, and pancreatic cysts.     

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

Endoscopic ultrasonography (EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography, computed tomography (CT) and transabdominal ultrasound for recognising early pancreatic tumors. As a diagnostic modality for pancreatic cancer, EUS has proved rates higher than 90%, especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT. Besides, EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer. The complication rate of EUS is as low as 1.1%-3.0%. New technical developments such as elastography and the use of contrast agents have recently been applied to EUS, improving its diagnostic capability. EUS has been found to be superior to the recent multidetector CT for T staging with less risk of overstaying in comparison to both CT and magnetic resonance imaging, so that patients are not being ruled out of a potentially beneficial resection. The accuracy for N staging with EUS is 64%-82%. In unresectable cancers, EUS also plays a therapeutic role by means of treating oncological pain through celiac plexus block, biliary drainage in obstructive jaundice in patients where endoscopic retrograde cholangiopancreatography is not affordable and aiding radiotherapy and chemotherapy.     

高能聚集超声热疗为主综合治疗晚期胰腺癌的临床观察

目的:探讨以高能聚焦超声热疗(HIFU)为主综合治疗不能手术切除晚期胰腺癌的近期疗效。方法:采用FEP-BY01型高能聚焦超声肿瘤治疗机联合介入或全身化疗、胆总管造口术(合并黄疸者)等措施,对23例不能手术切除的晚期胰腺癌患者进行综合治疗。结果:(1)疼痛改变:23例患者治疗前均有不同程度疼痛,治疗后完全缓解13例(56·5%),部分缓解8例(37·8%),无效2例(8·7%),与治疗前比较差异显著(P<0·01);(2)生活质量(KPS评分):治疗前平均(56·62±13·05)分,治疗后(85·20±5·20)分(P<0·01);(3)近期生存情况:本组病例HIFU治疗后至首次随访时,生存21例,2例分别因合并广泛肝转移和大量腹水全身衰竭死亡;(4)肿瘤体积变化:23例患者肿瘤完全消失1例,部分消失2例,肿瘤体积变化<1/4处于稳定状态17例,病情进展1例,死亡2例。结论:以超声聚焦热疗为主联合化疗及胆总管造口术等综合措施治疗不能手术切除的晚期胰腺癌,可以缓解疼痛,改善生活质量,其近期有效率高,值得进一步研究。