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有弹性的19G超声内镜引导下细针穿刺针的技术性能评估

发布日期:2014-1-29 12:40:49 文章来源:GIE 作者次数:1671
    背景

    目前我们已经开发出镍钛制细针,它有着较好的弹性,克服了现有的超声内镜引导下的细针穿刺针(19G)的局限性。

    目的

    评估经十二指肠行细针穿刺,获取组织学样本和采用有弹性的19G细针行治疗干预的能力。

    设计

    前瞻性队列研究。

    环境

    三级学术医疗中心。

    患者

    上皮下肿块患者,胰头或钩状病变或毗邻胰头病变患者以及接受治疗干预的患者。

    干预

    采用有弹性的19G细针穿刺针进行组织获取和干预。

    主要测量指标

    评估采用有弹性的19G细针穿刺针行经十二指肠穿刺的能力。此外,还评估了该针取得细胞学和组织学样品以及执行治疗干预的实用性。

    结果

    本研究共纳入50例患者,对38例患者进行组织获取,12例患者进行治疗干预。在38例获取组织的患者中,32例患者的组织样品是来自胰头/钩状或胰周肿块,6例患者组织样品来自上皮下肿块。我们成功地对38例患者进行了组织获取(包括经十二指肠穿刺),而且所获得的样品足够进行细胞学评估,即成功率为100%。自36例患者中取得的组织学标本令人满意,即占94.7%36/38)。对38例患者中的35例进行现场诊断,即比例为92.1%。在3例不确定/疑似病变的患者中,经组织学1例得到确定性诊断。每例患者接受的平均穿刺次数为1.45 ± 0.79。我们对12例患者成功进行了治疗干预,成功率为100%,其中包括假性囊肿引流5例,骨盆脓肿引流2例,基准植入2例,腹腔神经节阻滞2例,胆道造影1例。此外,本研究未出现细针功能障碍或手术并发症。

    局限性

    单中心研究,力量有限。

    结论

    初步数据表明,有弹性的19G细针可用于获取细胞学抽吸物和组织学样本,甚至可用于经十二指肠路径行治疗干预。但仍需在一项较大的且有不同病理条件的患者队列中实施验证性研究,以验证这些结果。

    缩写词:PFC,胰腺液体积聚;TBNTrucut 活检针。

     


    Assessment of the technical performance of the flexible 19-gauge EUS-FNA needle

    Background

    A needle made of nitinol has been developed with enhanced flexibility to overcome the limitations of the currently available 19-G EUS-FNA needles.

    Objective

    Evaluate the ability to perform transduodenal FNAs, procure histologic specimens, and undertake therapeutic interventions using the flexible 19-G needle.

    Design

    Prospective cohort study.

    Setting

    Tertiary-care academic medical center.

    Patients

    Consecutive patients with subepithelial masses, pancreatic head or uncinate lesions, or lesions adjacent to the pancreatic head, and patients undergoing therapeutic intervention.

    Interventions

    Perform tissue acquisition and interventions with the flexible 19-G FNA needle.

    Main Outcome Measures

    Evaluate the ability to perform transduodenal passes with the flexible 19-G FNA needle. Also, assess the utility of the needle to yield both cytologic and histologic samples and to perform therapeutic interventions.

    Results

    Of the 50 patients enrolled, tissue acquisition was undertaken in 38 and therapeutic intervention in 12. Of 38 patients from whom tissue was procured, 32 tissue samples were from pancreatic head/uncinate or peripancreatic masses and 6 were from subepithelial masses. Tissue acquisition, which included transduodenal passes, was successful and adequate for cytologic assessment in all 38 patients (100%). Satisfactory histologic specimens were procured from 36 of 38 (94.7%) patients. An onsite diagnosis was established in 35 of 38 (92.1%) patients. In 3 patients with indeterminate/suspicious lesions, a definitive diagnosis was established at histology. A mean of 1.45 ± 0.79 passes per patient was performed. All 12 therapeutic interventions were successful (100%) and included pseudocyst drainage in 5, pelvic abscess drainage in 2, fiducial placement in 2, celiac plexus neurolysis in 2, and cholangiogram in 1. Needle dysfunction or procedural complications were not encountered.

    Limitations

    Single-center study with limited power.

    Conclusions

    Preliminary data suggest that the flexible 19-G needle can be used for procuring cytologic aspirates and histologic specimens and to undertake therapeutic interventions even by the transduodenal route. Confirmatory studies are required in a larger cohort of patients with varied pathologic conditions to validate these findings.

    Abbreviations:  PFC, pancreatic fluid collection, TBN, Trucut biopsy needle

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