CAJ | 학술논문

目的评价内镜超声引导下细针穿刺活检术(EUS-FNA)在影像学拟诊为肝脏恶性肿瘤患者中的临床应用价值.方法回顾29例经影像学拟诊为肝脏恶性肿瘤行EUS-FNA检查患者的临床资料,总结细胞学、组织学、病理学诊断结果以及随访并发症发生情况.结果 29例共穿刺29处肝脏占位(尾状叶8处、左叶19处、右叶深部2处),穿刺32处非肝脏占位(胰腺9处、胆囊2处、胃壁1处、肺1处、右肾上腺1处、淋巴结18处).61处(100.0％)均能行细胞学检查,56处(91.8％,56/61)能行组织学检查,48处(78.7％,48/61)能行免疫组化检查.病理学诊断为原发性肝癌8例,其中1例肝脏病灶细胞学和组织学均无阳性发现,经同时肝门淋巴结细胞学明确诊断,其余7例(87.5％,7/8)肝脏病灶细胞学和组织学均为阳性；病理学诊断为转移性肝癌21例,肝脏病灶细胞学、组织学和病理学阳性率分别为76.2％(16/21)、85.7％(18/21)和100.0％(21/21),所有病变部位(包括肝脏、原发病灶和肿大淋巴结)的病理学阳性率达98.0％(48/49).所有患者未发生明显的并发症.结论基于深部肝脏与贲门、胃和十二指肠的局部解剖关系,EUS-FNA对于肝脏尾状叶、左叶和右叶深部的恶性肿瘤有肯定的诊断价值,是经皮肝脏穿刺活检的重要补充,应受到临床重视.
목적 평개내경초성인도하세침천자활검술(EUS-FNA)재영상학의진위간장악성종류환자중적림상응용개치.방법 회고29례경영상학의진위간장악성종류행EUS-FNA검사환자적림상자료,총결세포학、조직학、병이학진단결과이급수방병발증발생정황.결과 29례공천자29처간장점위(미상협8처、좌협19처、우협심부2처),천자32처비간장점위(이선9처、담낭2처、위벽1처、폐1처、우신상선1처、림파결18처).61처(100.0％)균능행세포학검사,56처(91.8％,56/61)능행조직학검사,48처(78.7％,48/61)능행면역조화검사.병이학진단위원발성간암8례,기중1례간장병조세포학화조직학균무양성발현,경동시간문림파결세포학명학진단,기여7례(87.5％,7/8)간장병조세포학화조직학균위양성；병이학진단위전이성간암21례,간장병조세포학、조직학화병이학양성솔분별위76.2％(16/21)、85.7％(18/21)화100.0％(21/21),소유병변부위(포괄간장、원발병조화종대림파결)적병이학양성솔체98.0％(48/49).소유환자미발생명현적병발증.결론 기우심부간장여분문、위화십이지장적국부해부관계,EUS-FNA대우간장미상협、좌협화우협심부적악성종류유긍정적진단개치,시경피간장천자활검적중요보충,응수도림상중시.
Objective To investigate the diagnostic value of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy in hepatic mass suspicious of malignancy.Methods This study retrospectively analyzed the clinical data of 29 patients (17 males and 12 females) with suspected hepatic malignancy aged from 30 to 80 years (mean 57 ±9.7 years).The yield of EUS-FNA were assessed by cell smear and histological examination.All patients were under close observation for complications after EUS-FNA.Results A total of 29 hepatic lesions (8 in caudate lobe,19 in left lobe,and 2 in right lobe) and 32 extrahepatic lesions (9 in pancreas,2 in gallbladder,1 in stomach,1 in lung,1 in right adrenal gland and 18lymph nodes) were fine-needle aspirated.All samples (61/61) were suitable for cell smear,91.8％(56/61) for hematoxylin-eosin staining and 78.7％ (48/61) for immunohistochemistry.In 29 patients,8 were diagnosed as primary hepatic cancer (6 hepatocellular cancer,2 cholangiocellular cancer),and 21 were diagnosed as metastatic hepatic malignancy with 9 from pancreatic cancer,3 from gallbladder cancer,2 from lung cancer,1 from gastric stromal tumor,1 from gastric cancer,3 from colorectal cancer and 2 from cancer with un-identified origin.No procedure related complications were observed in 29 patients.Conclusion Given the relationship between hepatic caudate lobe and cardia,left lobe and proximal stomach,deep right lobe and duodenum in topographic anatomy,and that EUS can easily scan enlarged mediastinal and retroperitoneal lymph nodes simultaneously and guide FNA,EUS and EUS-FNA should be weighted in clinical practice.