内镜超声检查对十二指肠乳头癌术前分期的诊断价值及影响因素分析

杨佳; 王梓义; 陈磊; 张耀; 陈静; 高莉萍; 冯晓峰

doi:10.16016/j.2097-0927.202312048

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内镜超声检查对十二指肠乳头癌术前分期的诊断价值及影响因素分析

临床医学 | 更新时间：2026-01-09

- 内镜超声检查对十二指肠乳头癌术前分期的诊断价值及影响因素分析
- Diagnostic value of endoscopic ultrasonography for duodenal papillary carcinoma and analysis on influencing factors
- 陆军军医大学学报 2024年46卷第22期页码：2561-2568
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院消化内科
  2.400038 重庆，陆军军医大学(第三军医大学)军事预防医学系军队流行病学教研室
  3.400038 重庆，陆军军医大学(第三军医大学)第一附属医院整形外科
- 作者简介：
  
  [冯晓峰，E-mail: crazyfxf@sina.comFENG Xiaofeng, E-mail: crazyfxf@sina.com
- 基金信息：
  
  重庆市卫生适宜技术推广项目(2023jstg005)
- DOI：10.16016/j.2097-0927.202312048
  中图分类号： R181.32;R730.41;R735.31
- 收稿：2023-12-08，
  
  修回：2024-09-06，
  
  纸质出版：2024-11-30
- 稿件说明：
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杨佳, 王梓义, 陈磊, 等. 内镜超声检查对十二指肠乳头癌术前分期的诊断价值及影响因素分析[J]. 陆军军医大学学报, 2024,46(22):2561-2568.

Jia YANG, Ziyi WANG, Lei CHEN, et al. Diagnostic value of endoscopic ultrasonography for duodenal papillary carcinoma and analysis on influencing factors[J]. Journal of Army Medical University, 2024, 46(22): 2561-2568.
杨佳, 王梓义, 陈磊, 等. 内镜超声检查对十二指肠乳头癌术前分期的诊断价值及影响因素分析[J]. 陆军军医大学学报, 2024,46(22):2561-2568. DOI： 10.16016/j.2097-0927.202312048.

Jia YANG, Ziyi WANG, Lei CHEN, et al. Diagnostic value of endoscopic ultrasonography for duodenal papillary carcinoma and analysis on influencing factors[J]. Journal of Army Medical University, 2024, 46(22): 2561-2568. DOI： 10.16016/j.2097-0927.202312048.

摘要

目的

评估内镜超声检查(endoscopic ultrasonography，EUS)在十二指肠乳头癌术前分期和导管扩张中的诊断价值，分析其诊断准确度的影响因素。

方法

采用横断面研究设计，收集2018年1月至2023年8月于本院消化内科就诊且经病理诊断为十二指肠乳头癌并接受EUS的患者，采用灵敏度、特异度、阳性预测值、阴性预测值和准确度评价EUS对十二指肠乳头癌术前分期的诊断价值。单因素和多因素分析确定影响EUS诊断准确度的因素。

结果

本研究共纳入102例经病理诊断确诊为十二指肠乳头癌的患者，其中男性59例，女性43例。患者平均年龄为62岁。患者确诊前均接受EUS，EUS对肿瘤T分期的准确度为86.27%，对T1、T2、T3、T4病变的灵敏度和特异度分别是84.21%、92.31%、85.00%、60.00%和95.31%、88.89%、96.34%、98.97%。T1、T2、T3、T4病变T分期的阳性预测值分别为91.43%、83.72%、85.00%、75.00%，阴性预测值分别为91.04%、94.92%、96.34%、97.96%。有14例患者的T分期被EUS错误分期。EUS评估导管内扩张的准确度为75.49%，对导管扩张的敏感性、特异性、阳性预测值和阴性预测值分别为96.97%、66.67%、98.97%、40.00%。EUS对胰管扩张诊断准确度的独立预测因素为神经浸润、肿瘤大小和T分期；而对胆管扩张诊断准确度的独立危险因素为神经浸润和碱性磷酸酶。

结论

EUS对十二指肠乳头癌术前分期诊断价值高，神经浸润、肿瘤大小、T分期、碱性磷酸酶可能是其诊断准确度的影响因素。

Abstract

Objective

To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in the preoperative staging and ductal dilatation of duodenal papillary carcinoma and analyze the factors influencing its diagnostic accuracy.

Methods

A cross-sectional trial was conducted on the patients with pathologically-diagnosed duodenal papillary carcinoma and undergoing EUS in the First Affiliated Hospital of Army Medical University from January 2018 to August 2023. The diagnostic value of EUS for the preoperative staging of duodenal papillary carcinoma was evaluated using sensitivity

specificity

positive predictive value

negative predictive value

and accuracy. Univariate and multivariate analyses were performed to determine the factors affecting the diagnostic accuracy of EUS.

Results

A total of 102 patients with duodenal papillary carcinoma were included

including 59 males and 43 females

at a mean age of 62 years

and all of them underwent EUS before diagnosis. The accuracy of EUS for tumor T-staging was 86.27%

the sensitivity and specificity for T1

and T4 lesions were 84.21%

92.31%

85.00%

60.00%

and 95.31%

88.89%

96.34%

and 98.97%

respectively. The positive predictive value for T-staging of T1

and T4 lesions was 91.43%

83.72%

85.00%

and 75.00%

and the negative predictive values were 91.04%

94.92%

96.34%

and 97.96%

respectively. There were 14 patients whose T-staging was incorrectly staged by EUS. The accuracy of EUS in assessing intraductal dilatation was 75.49%

and the sensitivity

specificity

positive predictive value

and negative predictive value for ductal dilatation were 96.97%

66.67%

98.97%

and 40.00%

respectively. In addition

the independent predictors of diagnostic accuracy of EUS for pancreatic duct dilatation were nerve infiltration

tumor size

and T stage; whereas the independent risk factors for diagnostic accuracy of bile duct dilatation were nerve infiltration and alkaline phosphatase.

Conclusion

EUS has quite higher diagnostic value for preoperative staging of duodenal papillary carcinoma

and nerve infiltration

tumor size

T stage

T stage and alkaline phosphatase may be the influencing factors for its diagnostic accuracy.

关键词

Keywords

references

BOHNACKER S, SEITZ U, NGUYEN D, et al . Endoscopic resection of benign tumors of the duodenal papilla without and with intraductal growth[J ] . Gastrointest Endosc, 2005, 62(4): 551-560. DOI: 10.1016/j.gie.2005.04.053.

程佳琪, 聂占国. 内镜下切除十二指肠乳头部腺瘤的研究进展[J]. 现代消化及介入诊疗, 2022, 27(10): 1352-1356. DOI: 10.3969/j.issn.1672-2159.2022.10.028.

CHENG J Q, NIE Z G. Research progress of endoscopic resection of duodenal papillary adenoma[J]. Mod Interv Diagn Treat Gastroenterol, 2022, 27(10): 1352-1356. DOI: 10.3969/j.issn.1672-2159.2022.10.028.

NAKAGAWA K, SHO M, FUJISHIRO M, et al . Clinical practice guidelines for duodenal cancer 2021[J ] . J Gastroenterol, 2022, 57(12): 927-941. DOI: 10.1007/s00535-022-01919-y.

KIM K, CHIE E K, JANG J Y, et al . Role of adjuvant chemoradiotherapy for duodenal cancer: a single center experience[J ] . Am J Clin Oncol, 2012, 35(6): 533-536. DOI: 10.1097/COC.0b013e31821dee31.

WALTER D, SCHNITZBAUER A A, SCHULZE F, et al . The diagnosis and treatment of ampullary carcinoma[J ] . Dtsch Arztebl Int, 2023, 120(43): 729-735. DOI: 10.3238/arztebl.m2023.0195.

乔新伟, 邱煜婷, 李鹏, 等. 十二指肠乳头肿瘤患者的临床特征分析及其对肿瘤进展期的诊断价值[J]. 首都医科大学学报, 2023, 44(6): 990-998. DOI: 10.3969/j.issn.1006-7795.2023.06.014.

QIAO X W, QIU Y T, LI P, et al . Analysis of clinical characteristics of patients with duodenal papilla neoplasms and the diagnostic value for advanced carcinoma[J ] . J Cap Med Univ, 2023, 44(6): 990-998. DOI: 10.3969/j.issn.1006-7795.2023.06.014.

GUO Q X, DING X W, LV F, et al . Diagnostic value of endoscopic ultrasonography in periampullary duodenal tumours[J ] . J Minim Access Surg, 2023, 19(4): 540-543. DOI: 10.4103/jmas.jmas_240_22.

王晨欢, 王子恺. 十二指肠乳头肿瘤的内镜诊治研究进展[J]. 中国微创外科杂志, 2024, 24(3): 217-223.

WANG C H, WANG Z K. Advances in endoscopic diagnosis and treatment of duodenal papillary tumors[J]. Chin J Min Inv Surg, 2024, 24(3): 217-223.

杨为中, 丁烁, 李云玖, 等. Hb、Alb及PLR与壶腹周围癌患者胰十二指肠切除术后并发症及临床预后的关系分析[J]. 疑难病杂志, 2023, 22(10): 1016-1020, 1026. DOI: 10.3969/j.issn.1671-6450.2023.10.002.

YANG W Z, DING S, LI Y J, et al . Analysis of the relationship between Hb, Alb, and PLR with postoperative complications and clinical prognosis after pancreaticoduodenectomy[J ] . Chin J Diffic Compl Cas, 2023, 22(10): 1016-1020, 1026. DOI: 10 .3969/j.issn.1671-6450.2023.10.002.

叶可柯, 顾剑锋, 张星鑫. 内镜十二指肠乳头肿瘤切除术研究进展[J]. 中国医学创新, 2022, 19(32): 164-169. DOI: 10.3969/j.issn.1674-4985.2022.32.036.

YE K K, GU J F, ZHANG X X. Recent progress in endoscopic papillectomy tumor resection[J]. Med Innov China, 2022, 19(32): 164-169. DOI: 10.3969/j.issn.1674-4985.2022.32.036.

任俊杰, 安晨杰, 李晓光, 等. 正常十二指肠乳头MSCT及与十二指肠乳头癌的对照研究[J]. CT理论与应用研究, 2022, 31(1): 111-116. DOI: 10.15953/j.1004-4140.2022.31.01.13.

REN J J, AN C J, LI X G, et al . Comparative study of multi-slice CT between normal duodenal papilla and duodenal papillary carcinoma[J ] . CT Theory Appl, 2022, 31(1): 111-116. DOI: 10.15953/j.1004-4140.2022.31.01.13.

张能维, 周孝思. 十二指肠乳头肿瘤的诊断和治疗[J]. 中国实用外科杂志, 1998, 18(7): 10-11.

ZHANG N W, ZHOU X S. Diagnosis and treatment of duodenal papilla tumor[J]. Chin J Pract Surg, 1998, 18(7): 10-11.

WEI W Y, MO W X, WANG N, et al . Research and analysis on computed tomography signs and clinical characteristics of chronic duodenal papilla mucositis and duodenal papillary carcinoma[J ] . Int J Immunopathol Pharmacol, 2023, 37: 3946320231157868. DOI: 10.1177/0394632 0231157868.

DEPALMA G D. Endoscopic papillectomy: indications, techniques, and results[J]. World J Gastroenterol, 2014, 20(6): 1537-1543. DOI: 10.3748/wjg.v20.i6.1537.

陈乃刚. CT增强扫描与十二指肠镜检查技术联合应用对壶腹周围癌诊断价值的研究[D]. 济南: 山东中医药大学, 2015.

CHEN N G. Study on the diagnostic value of enhanced CT scanning combined with duodenoscopy in periampullary cancer[D]. Jinan: Shandong University of Traditional Chinese Medicine, 2015.

AZIH L C, BROUSSARD B L, PHADNIS M A, et al . Endoscopic ultrasound evaluation in the surgical treatment of duodenal and peri-ampullary adenomas[J ] . World J Gastroenterol, 2013, 19(4): 511-515. DOI: 10.3748/wjg.v19.i4.511.

PENG C Y, LV Y, SHEN S S, et al . The impact of endoscopic ultrasound in preoperative evaluation for ampullary adenomas[J ] . J Dig Dis, 2019, 20(5): 248-255. DOI: 10.1111/1751-2980.12719.

YE X H, WANG L, JIN Z D. Diagnostic accuracy of endoscopic ultrasound and intraductal ultrasonography for assessment of ampullary tumors: a meta-analysis[J]. Scand J Gastroenterol, 2022, 57(10): 1158-1168. DOI: 10.1080/00365521.2022.2067785.

DE WILDE A J, DE JONG E J M, GURUSAMY K S, et al . Diagnostic accuracy of cross-sectional and endoscopic imaging in ampullary tumours: systematic review[J ] . Br J Surg, 2024, 111(1): znad432. DOI: 10.1093/bjs/znad432.

CHEN L J, WANG X Y, DAI J H, et al . Role of endoscopic ultrasound in the evaluation of unexplained extrahepatic bile duct dilatation[J ] . Eur J Gastroenterol Hepatol, 2023, 35(1): 73-79. DOI: 10.1097/MEG.0000000000002485.

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