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目的探讨胰腺囊腺癌的诊断方法。方法对126例胰腺囊性病变中36例恶性及90例良性病例的临床资料进行回顾性对照分析。结果B超及CT检查作为诊断胰腺囊腺癌的常用手段,其敏感性分别为52.8%和77.8%,特异性分别为78.9%和86.7%;囊内液CEA、CA19-9检查结合内镜超声(E超)引导下的细针穿刺细胞学检测敏感性可达94.4%,且与B超及CT检查的敏感性相比差异有统计学意义(χ2值分别为16.09和4.18,P<0.005,P<0.050)。囊内液CEA、CA19-9联合检测敏感性明显高于血清CEA、CA19-9联合检测(χ2=5.14,P<0.025)。上消化道X线钡餐及ERCP检查仅在当病变浸润胃肠道或主胰管时,才有诊断意义,并不能作为胰腺囊腺癌诊断的常规检测手段。结论E超引导下的细针穿刺细胞学检查联合囊内液CA19-9和CEA检测将成为胰腺囊腺癌诊断的可靠方法。但B超、CT及血清CEA、CA19-9检测作为胰腺囊腺癌常用的筛选检查,其作用亦不能忽视。
Objective To investigate the diagnosis of pancreatic cystadenocarcinoma. Methods 126 cases of pancreatic cystic lesions in 36 cases of malignant and 90 cases of benign clinical data were retrospectively controlled analysis. Results The B ultrasound and CT examination were commonly used in the diagnosis of pancreatic cystadenocarcinoma. The sensitivity and specificity were 52.8% and 77.8%, 78.9% and 86.7% respectively. CEA and CA19-9 in the cyst fluid combined with endoscopic ultrasonography (E), the sensitivity of fine needle aspiration cytology was 94.4%, and the difference was statistically significant compared with B ultrasound and CT (χ2 = 16.09 and 4.18, P <0.005, respectively) P <0.050). The sensitivity of CEA and CA19-9 was higher than that of CEA and CA19-9 (χ2 = 5.14, P <0.025). Upper gastrointestinal X-ray barium meal and ERCP examination only when the lesions infiltrating the gastrointestinal tract or the main pancreatic duct, have diagnostic significance, and can not be used as a routine diagnostic method of pancreatic cystadenocarcinoma. Conclusion E-guided fine needle aspiration cytology combined with intracapsular fluid CA19-9 and CEA detection will be a reliable method for the diagnosis of pancreatic cystadenocarcinoma. However, B ultrasound, CT and serum CEA, CA19-9 detection of pancreatic cystadenocarcinoma as a commonly used screening test, its role can not be ignored.