• 蘭州大學(xué)第二醫(yī)院，甘肅省消化系腫瘤重點實驗室(蘭州 730030);

目的 　介紹胰腺癌的內(nèi)鏡診治進(jìn)展。
方法 　查閱國內(nèi)、外近幾年有關(guān)胰腺癌內(nèi)鏡診治的文獻(xiàn)并做綜述。
結(jié)果 　近年來，隨著消化內(nèi)鏡的發(fā)展，特別是超聲內(nèi)鏡，超聲內(nèi)鏡下細(xì)針穿刺技術(shù)，逆行性胰膽管造影，內(nèi)鏡下胰管活檢、胰液中脫落細(xì)胞檢測、腫瘤標(biāo)志物檢測、經(jīng)口胰管鏡、光學(xué)相干體層攝影等技術(shù)的發(fā)展，胰腺癌的早期診斷率逐漸提高； 而且對于晚期胰腺癌，內(nèi)鏡下可開展支架置入、放射性粒子植入、神經(jīng)阻滯等多種治療。
結(jié)論 　消化內(nèi)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(nèi)鏡診治進(jìn)展. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 1027-1031. doi: 復(fù)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(nèi)鏡超聲檢查術(shù)對胰腺腫瘤早期診斷的價值 [J]. 中華內(nèi)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(qiáng), 楊云生, 等. 內(nèi)鏡下逆行胰膽管造影結(jié)合胰膽管腔內(nèi)超聲對胰腺癌診斷價值的研究 [J]. 中國實用內(nèi)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(jīng)內(nèi)鏡逆行胰膽管造影診治胰膽疾病610例分析 [J]. 中國實用內(nèi)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(nèi)鏡下胰液收集及腫瘤標(biāo)記物檢測對胰腺癌的診斷價值 [J]. 臨床內(nèi)科雜志, 2005; 26(6): 397-399.
17. 　劉楓, 李兆申, 許國銘. 胰液中腫瘤標(biāo)志物的檢測在胰腺癌診斷中的價值 [J]. 胃腸病學(xué), 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(qiáng), 等. 放射性粒子組織間種植治療腫瘤近期療效 [J]. 中國微創(chuàng)外科雜志, 2003; 3(2): 148-149.
42. 　金震東, 李兆申, 劉巖, 等. 超聲內(nèi)鏡引導(dǎo)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(nèi)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. 1. 　Murray D, Price R. What the endoscopist saw [J]. Br J Radiol, 2001; 74(887): 1074-1075.
  2. 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. 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. 4. 　金震東, 蔡振寨, 李兆申, 等. 內(nèi)鏡超聲檢查術(shù)對胰腺腫瘤早期診斷的價值 [J]. 中華內(nèi)科雜志, 2007； 46（12）： 984-987.
  5. 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. 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. 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. 8. 　韋璐, 令狐恩強(qiáng), 楊云生, 等. 內(nèi)鏡下逆行胰膽管造影結(jié)合胰膽管腔內(nèi)超聲對胰腺癌診斷價值的研究 [J]. 中國實用內(nèi)科雜志, 2008; 28(3): 197-199.
  9. 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. 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. 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. 12. 　Shimizu S, Kutsumi H, Fujimoto S, et al. Diagnostic endoscopic retrograde cholangiopancreatography [J]. Endoscopy, 1998; 30(2): 158-162.
  13. 13. 　王志勇, 馬世華, 李志娟. 經(jīng)內(nèi)鏡逆行胰膽管造影診治胰膽疾病610例分析 [J]. 中國實用內(nèi)科雜志, 2005; 25(8): 738-739.
  14. 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. 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. 16. 　周國雄, 黃介飛, 張弘, 等. 內(nèi)鏡下胰液收集及腫瘤標(biāo)記物檢測對胰腺癌的診斷價值 [J]. 臨床內(nèi)科雜志, 2005; 26(6): 397-399.
  17. 17. 　劉楓, 李兆申, 許國銘. 胰液中腫瘤標(biāo)志物的檢測在胰腺癌診斷中的價值 [J]. 胃腸病學(xué), 2000; 5(4): 248-250.
  18. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 28. 　Chen YK. Pancreatoscopy: present and future role [J]. Curr Gastroenterol Rep, 2007; 9(2): 136-143.
  29. 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. 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. 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. 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. 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. 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. 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. 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. 37. 　Strecker EP, Hagen B, Liermann D, et al. Current status of the Strecker stent [J]. Cardiol Clin, 1994; 12(4): 673-687.
  38. 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. 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. 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. 41. 　王俊杰, 黃毅, 冉維強(qiáng), 等. 放射性粒子組織間種植治療腫瘤近期療效 [J]. 中國微創(chuàng)外科雜志, 2003; 3(2): 148-149.
  42. 42. 　金震東, 李兆申, 劉巖, 等. 超聲內(nèi)鏡引導(dǎo)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(nèi)鏡雜志, 2006; 23(1): 15-18.
  43. 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. 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. 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. 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. 47. 　Caraceni A, Portenoy RK. Pain management in patients with pancreatic carcinoma [J]. Cancer, 1996； 78(Suppl 3): 639-653.
  48. 48. 　Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis [J]. Gastrointest Endosc, 1996; 44(6): 656-662.
  49. 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.