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目的探讨术中超声引导下精准Tru-cut活检在胰头实性肿块病理学诊断中的价值。方法对徐州医学院附属宿迁医院肝胆胰脾外科2010年8月至2011年8月期间收治的胰头实性肿块患者行术中超声引导下精准Tru-cut活检,共28例患者,男20例,女8例,年龄34～78岁,平均64岁;肿块最大径≤1.5 cm者5例(0.8～1.5 cm,平均1.2 cm,S组),1.5 cm<肿块最大径≤3.0 cm者7例(1.6～3.0 cm,平均2.5 cm,M组),肿块最大径>3.0 cm者16例(3.2～6.8 cm,平均4.8 cm,L组),每一肿块活检3针,每一条组织条均行快速冰冻检查,其结果与术后大标本石蜡切片病理结果分别比较。结果以患者为观察单位,所有病例诊断符合率为100%,无假阳性及假阴性。以单个组织条病理结果为观察单位,仅1条符合(1/3)、仅2条符合(2/3)和3条全符合(3/3)者分别为:S组是3例(3/5)、2例(2/5)、0例(0/5);M组是0例(0/7)、5例(5/7)、2例(2/7);L组是0例(0/16)、4例(4/16)、12例(12/16);在小病灶组(S组+M组)中的单条组织标本的假阴性率高于L组(χ2=9.833,P=0.002)。病灶小易出现单次穿刺假阴性结果。结论术中超声引导下精准Tru-cut活检能够准确确定胰头肿块的病理学诊断,安全有效,可为手术决策提供可靠依据。
Objective To investigate the value of intraoperative ultrasound-guided Tru-cut biopsy in the pathological diagnosis of solid tumors of the pancreas. Methods A total of 28 patients underwent ultrasound-guided ultra-precision Tru-cut biopsy in patients with hepatobiliary and pancreatic splenic surgery at Suqian Hospital, Xuzhou Medical College from August 2010 to August 2011. Twenty patients included 20 males , 8 females, aged 34 to 78 years old, average 64 years old; the largest diameter of tumor ≤ 1.5 cm in 5 cases (0.8 ~ 1.5 cm, average 1.2 cm, S group), 1.5 cm 3.0 cm, and 3 biopsies per mass. Rapid frozen check, the results and postoperative large specimens of paraffin sections pathological results were compared. The results of the patient as the unit of observation, all cases diagnosed in line with the rate of 100%, no false positive and false negative. Only one matched (1/3), only two matched (2/3) and three fully matched (3/3) were based on the histological results of single histological tissue. The patients in group S were 3 (3 / 5), 2 cases (2/5) and 0 case (0/5). There were 0 cases (0/7), 5 cases (5/7) and 2 cases 0 cases (0/16), 4 cases (4/16) and 12 cases (12/16). The false-negative rate of single tissue samples in small lesions group (S + M group) was higher than that in L group = 9.833, P = 0.002). Lesions prone to single puncture false negative results. Conclusion Intraoperative ultrasound-guided precision Tru-cut biopsy can accurately determine the pathological diagnosis of pancreatic head mass, which is safe and effective, which can provide a reliable basis for surgical decision-making.