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Objective To evaluate safety and efficacy of EUS-FNA for occupying pancreatic lesions.Methods Data of 62 patients with occupying pancreatic lesions,who underwent EUS-FNA between June 2011 and June 2014,were analyzed for completion and complications,with surgery and clinical follow-up as the golden standard.Accuracy,sensitivity and specificity of EUS-FNA were calculated.Results A total of 62 patients with pancreatic lesions successfully underwent EUS-FNA and median puncture number was 4.2(3 to 8).Success rate of puncture was 100％ and sampling satisfaction rate was 90.3％ (56/62).No complications such as fever,infection,bleeding,perforation,severe pancreatitis or death were found.With the final diagnosis as the golden standard(39 malignant lesions and 23 benign lesions),overall diagnostic accuracy of EUS-FNA was 88.7％(55/62).The cytology diagnostic accuracy was 69.4％ (43/62),significantly higher than that of the tissue pathology of 30.6％ (19/62,P＜0.01).Sensitivity and specificity of the procedure were 87.2％(34/39) and 91.3％(21/23) respectively.Conclusion EUS-FNA is an effective and safe procedure in diagnosis of occupying pancreatic lesions.
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Objective To analysis the clinical effects of biliary-pancreatic double stents in pancreatic cancer patients with obstructive jaundice.Methods From July 2008 to October 2011,a total of 60 patients with advanced pancreatic cancer were randomly divided into two groups to receive biliary-pancreatic double stents (n =28) or biliary stent only (n =32) according to the odd and even numbers of their admission date.Changes in liver function,abdominal pain,quality of life scores (QOL) were compared between two groups.Results The stents were placed successfully in 54 patients (90.0％),in which symptoms were relieved or gradually disappeared in all patients after the procedure.One week after stents placement,the serum total bilirubin decreased significantly from 164.32 ±45.16 μmol/L before ERCP to 63.25 ±27.06 μmol/L (P ＜ 0.05),other parameters including ALT,AST,AKP and r-GT were also decreased significantly compared with those of pre-ERCP (P ＜ 0.01),but there was no significant difference between the two groups (P ＞ 0.05).25 cases in double-stents group and 29 cases in single-stent group had varying degrees of pain relief at 7d after ERCP,but the overall pain relief rate and complete pain relief rate in double-stent group were significantly higher than those in single-stent group (92.0％ vs.55.2％; 64.0％ vs.34.5％,P＜0.05).At 7d and 14d after ERCP,Karnofsky QOL score were improved significantly in double-stent group (P ＜ 0.05).It was significantly better than single-stent group at 14d after ERCP (P ＜0.05).No death or other severe ERCP-related complications were observed.Conclusion Biliary-pancreatic stent placement for pancreatic cancer could significantly improve liver function and relieve obstructive pain.In the ways of alleviating pain and improving quality of life scores,it was better than ERCP biliary stent placement,especially for patients with pancreatic cancer combined obstructive pain.It indicated that biliary-pancreatic stent placement was better than simple biliary stent placement for advanced pancreatic head cancer patients with obstructive pain.
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The principle of Endoscopic Ultrasonography (EUS) is similar to abdominal ultrasonography. The difference between them is the installment of a high-frequency ultrasound miniature probe at the tip of the endoscope for real-time ultrasound scanning. The pancreas is a retroperitoneal organ. The insertion of the ultrasonic endoscope into the stomach and duodenum can clearly demonstrate the structure of the pancreas on ultrasound scanning. With the extensive application of EUS and development of endoscopic accessories, EUS is becoming more important and it plays an important role in the minimally invasive treatment of pancreatic diseases. EUS-FNA and injection technique, EUS-CPN,EUS-guided radiation seed implantation, endoscopic ultrasound-guided puncture and drainage of pancreatic pseudocyst broaden the application of EUS techniques. EUS will become another important minimally invasive endoscopic treatment for pancreatic diseases following ERCP.
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Objective: To investigate the diagnostic value and clinical significance of trans-splenic portal scintigraphy in cirrhotic portal hypertension and compensatory circulation. Methods: Transsplenic portal scintigraphy, ultrasound, and gastroscopy were performed on 50 patients with cirrhotic portal hypertension and on 10 controls. According to the Child-Pugh classification, 15 patients with cirrhosis were Child A, 19 cases were Child B, and 16 cases were Child C. Results: In the control group, the splenoportal vein was shaped like the letter S, and the portosystemic shunt index was 0.19?0.07. Portal hypertension portosystemic shunts were of 3 types: intrahepatic (13 patients; index, 0.52?0.19), compensatory(31 patients; index, 0.64?0.28)and completely extrahepatic (6 patients; index, 0.91?0.03). Collateral vessels were uphill, downhill, or complex. The portosystemic shunt index increased as cirrhosis and esophageal varices increased. There was statistical significance among groups(P
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Y0, then the diagnosis of hypertension with liver cirrhosis obtained. The positive rate of diagnosis is 95% and the specificity is 96% and 91% respectively, much better than those in type B ultrasonography or gastric endoscopy, 78% or 75% respectively (P