CT导引在胰腺和法特壶腹区活检中的应用

目的评估CT导引细针穿刺在胰腺和法特（Vater）壶腹区活检中的临床应用价值。方法回顾性研究中日友好医院自1985年8月至2004年12月CT导引细针穿刺胰腺和法特壶腹区106例，男71例，女35例，年龄21～74岁，平均48．7岁。患者就诊症状多为腹部不适、腹痛、消瘦乏力，部分有不同程度的皮肤黄染和上腹部包块。术前均作CT平扫和增强扫描，均采用前入路进针。穿刺活检部位分布为胰头壶腹区70例，胰体24例，胰尾12例。病灶大小1．5～5em；〈3em32例，≥3cm74例。使用22G（84例）和20G（22例）细针穿刺。穿刺活检要点为选择最佳层面和进针点，作多点扇状快速穿刺抽吸。活检标本送病理科作细胞病理学检查。结果106例均安全地穿刺到病变内，活检刺中率为100％。穿刺活检诊断为恶性病变78例，良性18例，真阴性3例，假阴性7例。穿刺活检总正确率、敏感性和特异性分别为93％、93％和100％。CT导引活检对恶性、良性病变的正确率为94％和90％（P〉0．05）。较大肿块病灶〈3cm28／32（88％），≥3．0cm 71／74（96％）]和病变位于胰尾（胰尾100％，胰头壶腹区93％，胰体92％）的正确率稍高，经统计学检验正确率差异没有统计学意义（P〉0．05），未发现严重的并发症。结论CT导引经皮细针穿刺胰腺和壶腹区活检是一种安全的有效的并发症发生率低的诊断和鉴别诊断方法。

Application of computed tomography guided percutaneous fine-needle aspiration biopsy in examination of pancreas and Vater's ampulla

OBJECTIVE: To evaluate the effects of computed tomography (CT) guided percutaneous fine-needle aspiration biopsy (FANB) in examination of pancreas and Vater's ampulla. METHODS: One hundred and six patients, 71 males and 35 females, aged 21 approximately 74, with lesions located in the pancreas and Vater's ampulla, 1.5 approximately 5 cm in size (< 3 cm in 32 cases and >or= 3 cm in 74 cases), underwent CT guided percutaneous FANB with 22-gauge needle (in 84 cases) or 20-gauge needle (in 22 cases) by anterior approach. The biopsy sites included the head of pancreas and ampulla (n = 70), body of pancreas (n = 24), and tail of pancreas (n = 12). The key points of FANB included selection of appropriate cross-section, entry of needle, and multiple insertion in fan-like fashion with fast puncture and aspiration. Pathological examination was done to all biopsy specimens. RESULTS: All lesions were safely accessed with an accuracy rate of 100% and without major complications. Pathological examination showed that 83 lesions were malignant, 5 of which were confirmed as false-positive, and 20 lesions were benign 2 of which were confirmed as false-negative, and 3 lesions were true-negative. The accuracy rates of diagnosis of malignant lesions and of diagnosis of benign lesion were 94% and 90% respectively (P > 0.05). The accuracy rate of diagnosis was 96% for the lesions >or= 3 cm was 96% and 88% for the lesions < 3 cm (P > 0.05). The accuracy rates of diagnosis were 93%, 92%, and 100% for the lesions located in the head of pancreas and ampulla of Vater, body of pancreas, and tail of pancreas (P > 0.05). CONCLUSION: CT guided percutaneous FANB is a safe and effective method for the diagnosis and differential diagnosis of lesions in the pancreas.