胰腺癌的內鏡診治進展_《中國普外基礎與臨床雜志》

作者：

張德奎 , 李玉民

蘭州大學第二醫院，甘肅省消化系腫瘤重點實驗室(蘭州 730030);

關鍵詞：

胰腺癌消化內鏡支架早期診斷治療

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目的　介紹胰腺癌的內鏡診治進展。
方法　查閱國內、外近幾年有關胰腺癌內鏡診治的文獻并做綜述。
結果　近年來，隨著消化內鏡的發展，特別是超聲內鏡，超聲內鏡下細針穿刺技術，逆行性胰膽管造影，內鏡下胰管活檢、胰液中脫落細胞檢測、腫瘤標志物檢測、經口胰管鏡、光學相干體層攝影等技術的發展，胰腺癌的早期診斷率逐漸提高；而且對于晚期胰腺癌，內鏡下可開展支架置入、放射性粒子植入、神經阻滯等多種治療。
結論　消化內鏡提高了胰腺癌的早期診斷率，同時為晚期胰腺癌的治療提供了新的選擇。

引用本文： 張德奎,李玉民. 胰腺癌的內鏡診治進展. 中國普外基礎與臨床雜志, 2010, 17(10): 1027-1031. doi: 復制

1.	Murray D, Price R. What the endoscopist saw [J]. Br J Radiol, 2001; 74(887): 1074-1075.
2.	Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography [J]. Am J Gastroenterol, 2004; 99(3): 492-501.
3.	Furukawa T, Tsukamoto Y, Naitoh Y, et al. Evaluation of intraductal ultrasonography in the diagnosis of pancreatic cancer [J]. Endoscopy, 1993; 25(9): 577-581.
4.	金震東, 蔡振寨, 李兆申, 等. 內鏡超聲檢查術對胰腺腫瘤早期診斷的價值 [J]. 中華內科雜志, 2007； 46（12）： 984-987.
5.	Maguchi H. The roles of endoscopic ultrasonography in the diagnosis of pancreatic tumors [J]. J Hepatobiliary Pancreat Surg, 2004; 11(1): 1-3.
6.	Habr F, Akerman P. Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer [J]. Front Biosci, 2000; 5: E30-E35.
7.	Fujita N, Noda Y, Kobayashi G, et al. Endoscopic approach to early diagnosis of pancreatic cancer [J]. Pancreas, 2004; 28(3): 279-281.
8.	韋璐, 令狐恩強, 楊云生, 等. 內鏡下逆行胰膽管造影結合胰膽管腔內超聲對胰腺癌診斷價值的研究 [J]. 中國實用內科雜志, 2008; 28(3): 197-199.
9.	Iglesias-Garcia J, Larino-Noia J, Abdulkader I, et al. Quantitative endoscopic ultrasound elastography: An accurate method for the differentiation of solid pancreatic masses [J]. Gastroenterology, 2010 Jun 27. [Epub ahead of print].
10.	Kliment M, Urban O, Cegan M, et al. Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: the utility and impact on management of patients [J]. Scand J Gastroenterol, 2010 Jul 14. [Epub ahead of print].
11.	McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report [J]. Ann Surg, 1968; 167(5): 752-756.
12.	Shimizu S, Kutsumi H, Fujimoto S, et al. Diagnostic endoscopic retrograde cholangiopancreatography [J]. Endoscopy, 1998; 30(2): 158-162.
13.	王志勇, 馬世華, 李志娟. 經內鏡逆行胰膽管造影診治胰膽疾病610例分析 [J]. 中國實用內科雜志, 2005; 25(8): 738-739.
14.	Namieno T, Koito K, Nagakawa T, et al. Diagnostic features on images in primary small cell carcinoma of the pancreas [J]. Am J Gastroenterol, 1997; 92(2): 319-322.
15.	Nakaizumi A, Tatsuta M, Uehara H, et al. Cytologic examination of pure pancreatic juice in the diagnosis of pancreatic carcinoma. The endoscopic retrograde intraductal catheter aspiration cytologic technique [J]. Cancer, 1992; 70(11): 2610-2614.
16.	周國雄, 黃介飛, 張弘, 等. 內鏡下胰液收集及腫瘤標記物檢測對胰腺癌的診斷價值 [J]. 臨床內科雜志, 2005; 26(6): 397-399.
17.	劉楓, 李兆申, 許國銘. 胰液中腫瘤標志物的檢測在胰腺癌診斷中的價值 [J]. 胃腸病學, 2000; 5(4): 248-250.
18.	Nakaizumi A, Uehara H, Takenaka A, et al. Diagnosis of pancreatic cancer by cytology and measurement of oncogene and tumor markers in pure pancreatic juice aspirated by endoscopy [J]. Hepatogastroenterology, 1999; 46(25): 31-37.
19.	Chen R, Pan S, Duan X, et al. Elevated level of anterior gradient-2 in pancreatic juice from patients with pre-malignant pancreatic neoplasia [J]. Mol Cancer, 2010; 9: 149-160.
20.	Nakashima A, Murakami Y, Uemura K, et al. Usefulness of human telomerase reverse transcriptase in pancreatic juice as a biomarker of pancreatic malignancy [J]. Pancreas, 2009; 38(5): 527-533.
21.	Habbe N, Koorstra JB, Mendell JT, et al. MicroRNA 　miR-155 is a biomarker of early pancreatic neoplasia [J]. Cancer Biol Ther, 2009; 8(4): 340-346.
22.	Sitek B, Sipos B, Alkatout I, et al. Analysis of the pancreatic tumor progression by a quantitative proteomic approach and immunhistochemical validation [J]. J Proteome Res, 2009; 8(4): 1647-1656.
23.	Shirai Y, Sogawa K, Yamaguchi T, et al. Protein profiling in pancreatic juice for detection of intraductal papillary mucinous neoplasm of the pancreas [J]. Hepatogastroenterology, 2008; 55(86-87): 1824-1829.
24.	Jiang P, Watanabe H, Okada G, et al. Diagnostic utility of aberrant methylation of tissue factor pathway inhibitor 2 in pure pancreatic juice for pancreatic carcinoma [J]. Cancer Sci, 2006; 97(11): 1267-1273.
25.	Watanabe H, Okada G, Ohtsubo K, et al. Aberrant methylation of secreted apoptosis-related protein 2 (SARP2) in pure pancreatic juice in diagnosis of pancreatic neoplasms [J]. Pancreas, 2006; 32(4): 382-389.
26.	Sai JK, Suyama M, Kubokawa Y, et al. Pancreatic duct lavage cytology for the diagnosis of branch duct-type intraductalpapillary mucinous neoplasm of the pancreas [J]. Pancreas, 2008; 36(2): 216-217.
27.	Yasuda K, Sakata M, Ueda M, et al. The use of pancreatoscopy in the diagnosis of intraductal papillary mucinous tumor lesions of the pancreas [J]. Clin Gastroenterol Hepatol, 2005; 3(7 Suppl 1): S53-S57.
28.	Chen YK. Pancreatoscopy: present and future role [J]. Curr Gastroenterol Rep, 2007; 9(2): 136-143.
29.	Ringold DA, Shah RJ. Peroral pancreatoscopy in the diagnosis and management of intraductal papillarymucinous neoplasia and indeterminate pancreatic duct pathology [J]. Gastrointest Endosc Clin N Am, 2009; 19(4): 601-613.
30.	Murashima Y, Suga T, Koito K, et al. Peroral endoscopical diagnosis for the early stage of cancer in bilio-pancreatic system [J]. Rinsho Byori, 1990; 38(3): 231-239.
31.	Testoni PA, Mangiavillano B. Optical coherence tomography in detection of dysplasia and cancer of the gastrointestinal tract and bilio-pancreatic ductal system [J]. World J Gastroenterol, 2008; 14(42): 6444-6452.
32.	Testoni PA, Mangiavillano B, Albarello L, et al. Optical coherence tomography to detect epithelial lesions of the main pancreatic duct: an Ex Vivo study [J]. Am J Gastroenterol, 2005; 100(12): 2777-2783.
33.	Tham TC, Lichtenstein DR, Vandervoort J, et al. Pancreatic duct stents for “obstructive type” pain in pancreatic malignancy [J]. Am J Gastroenterol, 2000; 95(4): 956-960.
34.	Harada R, Kawamoto H, Fukatsu H, et al. Nonprevention of post-endoscopic retrograde cholangiopancreatographic pancreatitis by pancreatic stent after aspiration of pure pancreatic juice in patients with intraductal papillary mucinous neoplasms of the pancreas [J]. Pancreas, 2010; 39(3): 340-344.
35.	Nguyen-Tang T, Binmoeller KF, Sanchez-Yague A, et al. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction [J]. Endoscopy, 2010; 42(3): 232-236.
36.	Mezhir JJ, Brennan MF, Baser RE, et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified [J]. J Gastrointest Surg, 2009; 13(12): 2163-2169.
37.	Strecker EP, Hagen B, Liermann D, et al. Current status of the Strecker stent [J]. Cardiol Clin, 1994; 12(4): 673-687.
38.	Espinel J, Vivas S, Muoz F, et al. Palliative treatment of malignant obstruction of gastric outlet using an endoscopically placed enteral wallstent [J]. Dig Dis Sci, 2001; 46(11): 2322-2324.
39.	Holm HH, Stryer I, Hansen H, et al. Ultrasonically guided percutaneous interstitial implantation of iodine 125 seeds in cancer therapy [J]. Br J Radiol, 1981; 54(644): 665-670.
40.	Peretz T, Nori D, Hilaris B, et al. Treatment of primary unresectable carcinoma of the pancreas with I-125 implantation [J]. Int J Radiat Oncol Biol Phys, 1989; 17(5): 931-935.
41.	王俊杰, 黃毅, 冉維強, 等. 放射性粒子組織間種植治療腫瘤近期療效 [J]. 中國微創外科雜志, 2003; 3(2): 148-149.
42.	金震東, 李兆申, 劉巖, 等. 超聲內鏡引導下定向植入放射性125I粒子治療胰腺癌的臨床研究 [J]. 中國消化內鏡雜志, 2006; 23(1): 15-18.
43.	Jin Z, Du Y, Li Z, et al. Endoscopic ultrasonography-guided interstitial implantation of iodine 125-seeds combined with chemotherapy in the treatment of unresectable pancreatic carcinoma: a prospective pilot study [J]. Endoscopy, 2008; 40(4): 314-320.
44.	Liu Y, Lu Z, Zou DW, et al. Intraluminal implantation of radioactive stents for treatment of primary carcinomas of the peripancreatic-head region: a pilot study [J]. Gastrointest Endosc, 2009; 69(6): 1067-1073.
45.	Nori D, Merimsky O, Osian AD, et al. Palladium-103: a new radioactive source in the treatment of unresectable carcinoma of the pancreas: a phase Ⅰ-Ⅱ study [J]. J Surg Oncol, 1996; 61(4): 300-305.
46.	De Oliveira R, dos Reis MP, Prado WA. The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain [J]. Pain, 2004； 110（1-2）: 400-408.
47.	Caraceni A, Portenoy RK. Pain management in patients with pancreatic carcinoma [J]. Cancer, 1996； 78(Suppl 3): 639-653.
48.	Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis [J]. Gastrointest Endosc, 1996; 44(6): 656-662.
49.	Gunaratnam NT, Sarma AV, Norton ID, et al. A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain [J]. Gastrointest Endosc, 2001; 54(3): 316-324.

1. 　Murray D, Price R. What the endoscopist saw [J]. Br J Radiol, 2001; 74(887): 1074-1075.
2. 　Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography [J]. Am J Gastroenterol, 2004; 99(3): 492-501.
3. 　Furukawa T, Tsukamoto Y, Naitoh Y, et al. Evaluation of intraductal ultrasonography in the diagnosis of pancreatic cancer [J]. Endoscopy, 1993; 25(9): 577-581.
4. 　金震東, 蔡振寨, 李兆申, 等. 內鏡超聲檢查術對胰腺腫瘤早期診斷的價值 [J]. 中華內科雜志, 2007； 46（12）： 984-987.
5. 　Maguchi H. The roles of endoscopic ultrasonography in the diagnosis of pancreatic tumors [J]. J Hepatobiliary Pancreat Surg, 2004; 11(1): 1-3.
6. 　Habr F, Akerman P. Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer [J]. Front Biosci, 2000; 5: E30-E35.
7. 　Fujita N, Noda Y, Kobayashi G, et al. Endoscopic approach to early diagnosis of pancreatic cancer [J]. Pancreas, 2004; 28(3): 279-281.
8. 　韋璐, 令狐恩強, 楊云生, 等. 內鏡下逆行胰膽管造影結合胰膽管腔內超聲對胰腺癌診斷價值的研究 [J]. 中國實用內科雜志, 2008; 28(3): 197-199.
9. 　Iglesias-Garcia J, Larino-Noia J, Abdulkader I, et al. Quantitative endoscopic ultrasound elastography: An accurate method for the differentiation of solid pancreatic masses [J]. Gastroenterology, 2010 Jun 27. [Epub ahead of print].
10. 　Kliment M, Urban O, Cegan M, et al. Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: the utility and impact on management of patients [J]. Scand J Gastroenterol, 2010 Jul 14. [Epub ahead of print].
11. 　McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report [J]. Ann Surg, 1968; 167(5): 752-756.
12. 　Shimizu S, Kutsumi H, Fujimoto S, et al. Diagnostic endoscopic retrograde cholangiopancreatography [J]. Endoscopy, 1998; 30(2): 158-162.
13. 　王志勇, 馬世華, 李志娟. 經內鏡逆行胰膽管造影診治胰膽疾病610例分析 [J]. 中國實用內科雜志, 2005; 25(8): 738-739.
14. 　Namieno T, Koito K, Nagakawa T, et al. Diagnostic features on images in primary small cell carcinoma of the pancreas [J]. Am J Gastroenterol, 1997; 92(2): 319-322.
15. 　Nakaizumi A, Tatsuta M, Uehara H, et al. Cytologic examination of pure pancreatic juice in the diagnosis of pancreatic carcinoma. The endoscopic retrograde intraductal catheter aspiration cytologic technique [J]. Cancer, 1992; 70(11): 2610-2614.
16. 　周國雄, 黃介飛, 張弘, 等. 內鏡下胰液收集及腫瘤標記物檢測對胰腺癌的診斷價值 [J]. 臨床內科雜志, 2005; 26(6): 397-399.
17. 　劉楓, 李兆申, 許國銘. 胰液中腫瘤標志物的檢測在胰腺癌診斷中的價值 [J]. 胃腸病學, 2000; 5(4): 248-250.
18. 　Nakaizumi A, Uehara H, Takenaka A, et al. Diagnosis of pancreatic cancer by cytology and measurement of oncogene and tumor markers in pure pancreatic juice aspirated by endoscopy [J]. Hepatogastroenterology, 1999; 46(25): 31-37.
19. 　Chen R, Pan S, Duan X, et al. Elevated level of anterior gradient-2 in pancreatic juice from patients with pre-malignant pancreatic neoplasia [J]. Mol Cancer, 2010; 9: 149-160.
20. 　Nakashima A, Murakami Y, Uemura K, et al. Usefulness of human telomerase reverse transcriptase in pancreatic juice as a biomarker of pancreatic malignancy [J]. Pancreas, 2009; 38(5): 527-533.
21. 　Habbe N, Koorstra JB, Mendell JT, et al. MicroRNA 　miR-155 is a biomarker of early pancreatic neoplasia [J]. Cancer Biol Ther, 2009; 8(4): 340-346.
22. 　Sitek B, Sipos B, Alkatout I, et al. Analysis of the pancreatic tumor progression by a quantitative proteomic approach and immunhistochemical validation [J]. J Proteome Res, 2009; 8(4): 1647-1656.
23. 　Shirai Y, Sogawa K, Yamaguchi T, et al. Protein profiling in pancreatic juice for detection of intraductal papillary mucinous neoplasm of the pancreas [J]. Hepatogastroenterology, 2008; 55(86-87): 1824-1829.
24. 　Jiang P, Watanabe H, Okada G, et al. Diagnostic utility of aberrant methylation of tissue factor pathway inhibitor 2 in pure pancreatic juice for pancreatic carcinoma [J]. Cancer Sci, 2006; 97(11): 1267-1273.
25. 　Watanabe H, Okada G, Ohtsubo K, et al. Aberrant methylation of secreted apoptosis-related protein 2 (SARP2) in pure pancreatic juice in diagnosis of pancreatic neoplasms [J]. Pancreas, 2006; 32(4): 382-389.
26. 　Sai JK, Suyama M, Kubokawa Y, et al. Pancreatic duct lavage cytology for the diagnosis of branch duct-type intraductalpapillary mucinous neoplasm of the pancreas [J]. Pancreas, 2008; 36(2): 216-217.
27. 　Yasuda K, Sakata M, Ueda M, et al. The use of pancreatoscopy in the diagnosis of intraductal papillary mucinous tumor lesions of the pancreas [J]. Clin Gastroenterol Hepatol, 2005; 3(7 Suppl 1): S53-S57.
28. 　Chen YK. Pancreatoscopy: present and future role [J]. Curr Gastroenterol Rep, 2007; 9(2): 136-143.
29. 　Ringold DA, Shah RJ. Peroral pancreatoscopy in the diagnosis and management of intraductal papillarymucinous neoplasia and indeterminate pancreatic duct pathology [J]. Gastrointest Endosc Clin N Am, 2009; 19(4): 601-613.
30. 　Murashima Y, Suga T, Koito K, et al. Peroral endoscopical diagnosis for the early stage of cancer in bilio-pancreatic system [J]. Rinsho Byori, 1990; 38(3): 231-239.
31. 　Testoni PA, Mangiavillano B. Optical coherence tomography in detection of dysplasia and cancer of the gastrointestinal tract and bilio-pancreatic ductal system [J]. World J Gastroenterol, 2008; 14(42): 6444-6452.
32. 　Testoni PA, Mangiavillano B, Albarello L, et al. Optical coherence tomography to detect epithelial lesions of the main pancreatic duct: an Ex Vivo study [J]. Am J Gastroenterol, 2005; 100(12): 2777-2783.
33. 　Tham TC, Lichtenstein DR, Vandervoort J, et al. Pancreatic duct stents for “obstructive type” pain in pancreatic malignancy [J]. Am J Gastroenterol, 2000; 95(4): 956-960.
34. 　Harada R, Kawamoto H, Fukatsu H, et al. Nonprevention of post-endoscopic retrograde cholangiopancreatographic pancreatitis by pancreatic stent after aspiration of pure pancreatic juice in patients with intraductal papillary mucinous neoplasms of the pancreas [J]. Pancreas, 2010; 39(3): 340-344.
35. 　Nguyen-Tang T, Binmoeller KF, Sanchez-Yague A, et al. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction [J]. Endoscopy, 2010; 42(3): 232-236.
36. 　Mezhir JJ, Brennan MF, Baser RE, et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified [J]. J Gastrointest Surg, 2009; 13(12): 2163-2169.
37. 　Strecker EP, Hagen B, Liermann D, et al. Current status of the Strecker stent [J]. Cardiol Clin, 1994; 12(4): 673-687.
38. 　Espinel J, Vivas S, Muoz F, et al. Palliative treatment of malignant obstruction of gastric outlet using an endoscopically placed enteral wallstent [J]. Dig Dis Sci, 2001; 46(11): 2322-2324.
39. 　Holm HH, Stryer I, Hansen H, et al. Ultrasonically guided percutaneous interstitial implantation of iodine 125 seeds in cancer therapy [J]. Br J Radiol, 1981; 54(644): 665-670.
40. 　Peretz T, Nori D, Hilaris B, et al. Treatment of primary unresectable carcinoma of the pancreas with I-125 implantation [J]. Int J Radiat Oncol Biol Phys, 1989; 17(5): 931-935.
41. 　王俊杰, 黃毅, 冉維強, 等. 放射性粒子組織間種植治療腫瘤近期療效 [J]. 中國微創外科雜志, 2003; 3(2): 148-149.
42. 　金震東, 李兆申, 劉巖, 等. 超聲內鏡引導下定向植入放射性125I粒子治療胰腺癌的臨床研究 [J]. 中國消化內鏡雜志, 2006; 23(1): 15-18.
43. 　Jin Z, Du Y, Li Z, et al. Endoscopic ultrasonography-guided interstitial implantation of iodine 125-seeds combined with chemotherapy in the treatment of unresectable pancreatic carcinoma: a prospective pilot study [J]. Endoscopy, 2008; 40(4): 314-320.
44. 　Liu Y, Lu Z, Zou DW, et al. Intraluminal implantation of radioactive stents for treatment of primary carcinomas of the peripancreatic-head region: a pilot study [J]. Gastrointest Endosc, 2009; 69(6): 1067-1073.
45. 　Nori D, Merimsky O, Osian AD, et al. Palladium-103: a new radioactive source in the treatment of unresectable carcinoma of the pancreas: a phase Ⅰ-Ⅱ study [J]. J Surg Oncol, 1996; 61(4): 300-305.
46. 　De Oliveira R, dos Reis MP, Prado WA. The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain [J]. Pain, 2004； 110（1-2）: 400-408.
47. 　Caraceni A, Portenoy RK. Pain management in patients with pancreatic carcinoma [J]. Cancer, 1996； 78(Suppl 3): 639-653.
48. 　Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis [J]. Gastrointest Endosc, 1996; 44(6): 656-662.
49. 　Gunaratnam NT, Sarma AV, Norton ID, et al. A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain [J]. Gastrointest Endosc, 2001; 54(3): 316-324.

《中國普外基礎與臨床雜志》

胰腺癌的內鏡診治進展

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國普外基礎與臨床雜志》

胰腺癌的內鏡診治進展

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料