超声内镜在小胰癌诊断中的价值探讨

目的探讨超声内镜（EUS）在小胰癌的诊断、TNM分期和预测可切除性中的价值。方法回顾性分析手术病理确诊的10例肿瘤直径≤3cm的胰腺癌病人的临床资料以及B超（US）、螺旋CT、超声内镜（EUS）检查资料。结果10例小胰癌患者肿瘤平均直径1.92cm（0.8～3cm）；US检查有5例（50%）胰腺病变，螺旋CT检查有7例（70％）胰腺病变，超声内镜检查胰腺均有改变。EUS诊断肿瘤侵犯门脉系统的准确率100％，对肠系膜上动脉的浸润的诊断准确率略低；对肿瘤T分期的准确率90％，N分期为70％，“TN”分期为60％，根据EUS诊断10例患者均可行手术切除，而术中发现2例患者失去手术时机，阳性预测值80％。结论超声内镜检查对小胰癌的诊断、分期及可切除性的评估有重要意义，超声内镜是目前临床使用的各种影像技术中对小胰癌显示最好的方法，值得临床推广。

Approach of the Value of Endosonography in the Diagnosis of Small Pancreatic Carcinoma

Objective To approach the value of endosonography in diagnosing, TNM staging and predicting the resectability of small pancreatic carcinoma. Methods Medical records and findings of abdominal ultrasound （ US） , spiral computed tomography （ CT） and EUS were reviewed in 10 patients who were pathologically proven to be pancreatic adenocarcinoma which was ≤3cm in diameter. Results The average size of tumor was 1.92cm （ 0.8 - 3.0cm） ; US identified 5 patients （ 50% ） , spiral CT showed 7 patients （ 70% ） with a lesion, EUS identified pancreatic tumor in all patients. EUS accuracy in finding the portal system invasion was 100% , but for superior mesenteric artery invasion was lower. Its accuracy for tumour stage（T） was 90% , for stage（N） 70% , and TN staging was 60%. Ten patients were considered to be resectable by EUS with a positive predictive value of 80% in comparison with surgical findings. Conclusion EUS plays an important role in diagnosing, staging and predicting the resectability of small pancreatic carcinoma. EUS has become the best technique for diagnosing small pancreatic carcinoma in a variety of imaging technology in present study,and is worth spreading in clinic.