内镜超声引导下细针抽吸术诊断消化道周围占位性病变的临床价值及影响因素研究

Diagnostic value and influencing factors of endoscopic ultrasound-guided fine needle aspiration for space-occupying lesions of gastrointestinal adjacent tissue

摘要:

目的 探讨内镜超声引导下细针抽吸术（EUS-FNA）诊断消化道周围占位性病变的价值及其影响因素。 方法 回顾性分析2009年1月至2016年5月行EUS-FNA的171例患者的临床资料，纳入病灶部位、大小、性状，穿刺次数、穿刺时抽吸负压、穿刺针型号、医师操作经验等因素进行分析。 结果 EUS-FNA诊断消化道周围恶性占位性病变的敏感度、特异度和准确率分别为78.3％（83／106）、100.0％（65／65）、86.5％（148／171）。单因素logistic回归分析示，EUS-FNA诊断恶性占位性病变穿刺阳性率的影响因素有病灶部位、性状、大小。多因素logistic分析示，病灶大小（OR=1.029，95％CI：1.011～1.047，P=0.001）、病灶性状（实性及囊实性/囊性，OR=5.098，95％CI：1.324～19.633，P=0.018）是EUS-FNA诊断恶性占位性病变穿刺阳性率的独立影响因素。171例患者中，术后2例出现发热，1例出现急性胰腺炎，并发症发生率为1.75％（3／171），经保守对症处理后均好转。 结论 EUS-FNA是一项安全有效、敏感度和准确率高的细胞组织病理诊断手段，在鉴别消化道周围良恶性占位性病变中起重要作用。EUS-FNA诊断恶性占位性病变穿刺阳性率与病灶大小呈正相关，诊断实性恶性占位性病变的穿刺阳性率显著高于囊性病变。

Abstract:

Objective To investigate the diagnostic value of endoscopic ultrasound-guided fine needle aspiration （EUS-FNA） on malignant lesions in gastrointestinal adjacent tissue， and further to analyze the risk factors influencing positive rate of EUS-FNA. Methods The clinical data of 171 patients undergoing EUS-FNA from January 2009 to May 2016 were collected. The lesion location， size and characteristics， the number of needle passes， puncture suction negative pressure， size of puncture needle， and years of operator experience in EUS were retrospectively analyzed. Results The overall sensitivity， specificity， and accuracy of EUS-FNA in the diagnosis of malignant lesions were 78.3％ （83／106）， 100.0％ （65／65）， and 86.5％ （148／171）， respectively. The univariable logistic regression analysis demonstrated that the risk factors of EUS-FNA were lesion location， lesion characteristics， and lesion size. In multivariate analysis， larger lesion size （OR=1.029， 95％CI： 1.011-1.047， P=0.001） and lesion characteristics of solid （OR=5.098， 95％CI： 1.324-19.633， P=0.018） were independent factors affecting the positive rate of EUS-FNA. Among 171 cases performed by EUS-FNA， the incidence of postoperative complications was 1.75％ （3／171） included 2 cases of fever and 1 case of acute pancreatitis， which were improved after conservative treatment. Conclusion EUS-FNA is a safe and effective method of cytological and histological diagnosis with high accuracy and sensitivity， importantly in distinguish malignancy from benign lesion in gastrointestinal adjacent tissue. Positive rate of diagnosis on malignant lesions by EUS-FNA is positively correlated with lesion size， and EUS-FNA positive rate of solid malignant lesions is significantly higher than that of cystic lesions.