Yoon Won Jae, Daglilar Ebubekir S, Fernández-del Castillo Carlos, Mino-Kenudson Mari, Pitman Martha B, Brugge William R
Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Endoscopy. 2014 May;46(5):382-7. doi: 10.1055/s-0034-1364937. Epub 2014 Mar 11.
There have been concerns about peritoneal seeding after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of mucinous pancreatic cystic lesions. The aims of this study were to determine the frequency of postoperative peritoneal seeding in patients with intraductal papillary mucinous neoplasm (IPMN) who had undergone pre-operative EUS-FNA and to compare it with that of patients with IPMN who had surgery with no pre-operative tissue sampling.
A total of 175 patients who had undergone resection of IPMNs with pre-operative EUS-FNA (EUS-FNA group) were analyzed and compared with 68 patients who had undergone resection with no pre-operative tissue sampling (No Sampling group). Patient characteristics, pathology, and frequency of peritoneal seeding after surgery were analyzed and compared. Peritoneal seeding was diagnosed based on pathology or image findings.
The two groups were comparable with respect to sex, age, follow-up duration, involvement of the pancreatic head, involvement of the main duct, grade of dysplasia, and size of histologically proven branch-duct IPMNs. Four patients (2.3 %) with invasive IPMN developed peritoneal seeding in the EUS-FNA group, whereas three (4.4 %, two with invasive IPMN and one with high-grade dysplasia) developed peritoneal seeding in the No Sampling group (P = 0.403). No peritoneal seeding was noted during surgery in these cases. Except for one patient in the EUS-FNA group, no spillage occurred during resection in these patients.
In this cohort of patients undergoing resection of IPMN, the difference in the frequency of peritoneal seeding in the EUS-FNA group and the No Sampling group was not significant.
内镜超声引导下细针穿刺抽吸术（EUS-FNA）用于黏液性胰腺囊性病变后，人们一直担心会出现腹膜种植。本研究的目的是确定术前接受EUS-FNA的导管内乳头状黏液性肿瘤（IPMN）患者术后腹膜种植的发生率，并将其与未进行术前组织采样而接受手术的IPMN患者进行比较。
分析了175例术前接受EUS-FNA的IPMN切除患者（EUS-FNA组），并与68例未进行术前组织采样而接受手术的患者（无采样组）进行比较。分析并比较患者的特征、病理及术后腹膜种植的发生率。腹膜种植根据病理或影像结果诊断。
两组在性别、年龄、随访时间、胰头受累情况、主胰管受累情况、发育异常分级以及经组织学证实的分支导管IPMN大小方面具有可比性。EUS-FNA组有4例（2.3%）浸润性IPMN患者发生腹膜种植，而无采样组有3例（4.4%，2例浸润性IPMN和1例高级别发育异常）发生腹膜种植（P = 0.403）。这些病例在手术过程中均未发现腹膜种植。除EUS-FNA组的1例患者外，这些患者在切除过程中均未发生渗漏。
在这组接受IPMN切除术的患者中，EUS-FNA组和无采样组腹膜种植发生率的差异不显著。
