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目的探讨内镜超声检查术(EUS)、管内超声检查术(IDUS)及超声内镜引导下细针穿刺术(EUS-FNA)对胰腺肿瘤早期诊断的价值。方法回顾性分析和比较188例胰腺小占位病灶的EUS、IDUS、EUS-FNA 及其他影像学检查结果。结果 (1)EUS 诊断小胰腺癌的准确率是95.6%(44/46),优于 B 超58.6%(27/46)、CT 77.4%(24/31)、MRI 76.2%(16/21)及内镜逆行胰胆管造影术(ERCP)85.3%(29/34)。小胰腺癌 EUS 声像图主要表现为类圆形、边界清楚、边缘不规则的低回声肿块,内部回声多均匀。(2)25例胰腺小占位病灶行 IDUS 检查,其准确率是100.0%(25/25),明显优于 B 超32.0%(8/25)、CT 52.9%(9/17)及 MRI 57.9%(11/19)等检查。(3)18例胰腺小占位病灶行 EUS-FNA,其准确率是66.7%(12/18)。(4)EUS 诊断胰腺假性囊肿的准确率是100.0%(27/27),明显优于 B 超52.0%(13/25)、CT 66.7%(12/18)、MRI 82.4%(14/17)及 ERCP 78.9%(15/19);对胰腺囊性肿瘤分类鉴别诊断总的准确率是57.7%(15/26),优于 B 超19.2%(5/26)、CT36.4%(8/22)、MRI 37.5%(6/16)及 ERCP 50.0%(7/14)等检查。结论 EUS、IDUS 及 EUS-FNA 对胰腺肿瘤的早期诊断具有重要价值。
Objective To investigate the value of endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS) and endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) in the early diagnosis of pancreatic tumors. Methods We retrospectively analyzed and compared EUS, IDUS, EUS-FNA and other imaging findings in 188 small lesions of the pancreas. Results (1) The accuracy of EUS in diagnosing small pancreatic cancer was 95.6% (44/46), which was better than that of B ultrasound in 58.6% (27/46), 77.4% (24/31) in CT, 76.2% (16/21) And endoscopic retrograde cholangiopancreatography (ERCP) 85.3% (29/34). Small pancreatic cancer EUS sonography mainly for the round, clear boundary, irregular edge of the hypoechoic mass, the internal echo more uniform. (2) IDUS examination of 25 small pancreatic lesions showed that the accuracy was 100.0% (25/25), which was significantly better than that of B ultrasound (8/25), CT 52.9% (9/17) and MRI 57.9 % (11/19) and other checks. (3) The accuracy of EUS-FNA was 18.7% (12/18) in 18 cases of pancreatic small footprint lesions. (4) The accuracy of EUS in the diagnosis of pancreatic pseudocyst was 100.0% (27/27), which was significantly better than that of 52.0% (13/25) in B ultrasound, 66.7% (12/18) in CT, 82.4% in MRI ) And ERCP 78.9% (15/19). The overall accuracy of the differential diagnosis of pancreatic cystic tumors was 57.7% (15/26), better than B (19.2%), CT 36.4% (8 / 22), MRI 37.5% (6/16) and ERCP 50.0% (7/14) and other tests. Conclusion EUS, IDUS and EUS-FNA are of great value in the early diagnosis of pancreatic tumors.