谐波造影增强超声内镜技术在胰腺占位性疾病中的诊断作用研究

目的探讨谐波造影增强超声内镜技术（CEH—EUS）在胰腺占位性疾病中的诊断作用。方法选择胰腺疾病患者为检查对象，以EUS—FNA或组织病理学结果以及随访结果为最终诊断，评价CEH—EUS诊断胰腺疾病的准确性，并分析CEH—EUS检查下受检部位的增强情况，包括增强顺序、增强时向特点、增强模式分级以及静脉洗脱程度。结果共23例胰腺疾病患者入选本研究，经FNA和（或）组织病理确诊，13例为胰腺癌，7例为慢性胰腺炎，2例为胰管内乳头状产黏蛋白肿瘤，1例为胰腺微囊型浆液性囊腺瘤。CEH—EUS诊断准确率为95．65％，明显高于普通EUS诊断准确率（78．2％）。其中CEH—EUS显示13例胰腺癌病灶增强晚于周围组织或与周围组织同步，呈不均匀低增强或存在充盈缺损区域，无显著达峰表现，消退明显早于周围组织。慢性胰腺炎等良性胰腺疾病病灶处增强与周围组织基本同步，充盈均匀，消退与周围组织同步。结论CEH—EUS在胰腺疾病的诊断中可以安全、简便、准确地显示病灶血供情况，不仅可成为EUS—FNA的有力补充，同时为胰腺疾病的鉴别诊断提供了直接且有效的帮助。

Contrast-enhanced harmonic EUS in diagnosis of pancreatic occupying lesions

Objective To evaluate the accuracy of contrast-enhanced harmonic EUS (CEH-EUS) by using a second-generation contrast medium in differential diagnosis of pancreatic occupying lesions.Methods Patients with suspected pancreatic neoplasms or chronic pancreatitis were enrolled and underwent CEH-EUS by using ultrasonic contrast medium Sonovue.Cytological and/or histological diagnoses were made by EUS-FNA and the final follow-up results.Characteristics of enhancement of the target areas,such as enhancement sequence,time features,pattern grade and venous elution degree were investigated.Results A total of 23 patients were enrolled,in which 13 were diagnosed with FNA as having pancreatic cancer,7 with chronic pancreatitis,2 with intraductal papillary mucinous neoplasms and 1 with microcystic serous cystadenoma.The accuracy of CEH-EUS was 95.65％,which was significantly higher than that of conventional EUS (78.2％).Enhancement of pancreatic cancer by CEH-EUS was later than or simultaneous with the nearby tissues,with heterogeneous low enhancement or fulfillment defect areas,and early subsidence without obvious peak.Enhancement of benign pancreatic diseases was simultaneous with the surrounding tissues,with homogenous fulfillment and simultaneous subsidence.Conclusion CEH-EUS is safe,convenient and accurate in diagnosis of pancreatic occupying lesions and can be used as an additional diagnostic method to EUSFNA.