摘要目的:评价谐波造影增强超声内镜(CEH-EUS)在胰腺囊性病变中的诊断价值。方法:回顾性分析2013年3月至2020年4月间海军军医大学第一附属医院消化内科经EUS诊断为胰腺囊性病变且有CEH-EUS录像患者的内镜和临床随访资料。结果:共纳入36例患者，其中浆液性囊性肿瘤(SCA)16例、黏液性囊性肿瘤(MCN)10例、导管内乳头状黏液性肿瘤(IPMN)5例(3例混合型、2例主胰管型)、胰腺假性囊肿(PPC)5例。87.5%(14/16) SCA和86.7%(13/15) MCN+IPMN的囊壁呈造影高增强效应，达峰明显，消退与周围组织同步，而只有20%(1/5) PPC的囊壁呈高增强效应，PPC的高增强效应显著低于SCA、MCN+IPMN，差异均有统计学意义( P值分别为0.0035、0.0048)。共17例EUS检出胰腺囊性病变内存在壁结节，其中3例CEH-EUS检查显示为高增强回声，其余14例均显示为低增强回声。高增强回声的3例最终都诊断为恶性胰腺囊性肿瘤(1例IPMN，2例MCN)，诊断准确率达100%。 结论:CEH-EUS在区分PPC和其他胰腺囊性病变上具有明显优势，而区分MCN和SCA意义不大。胰腺囊性病变内壁结节在CEH-EUS模式下显示为高增强预示着恶变潜能。

abstractsObjective:To evaluate diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) for pancreatic cystic lesions.Methods:Endoscopic and clinical follow-up data of patients with pancreatic cystic lesions diagnosed by EUS in Department of Gastroenterology of the First Affiliated Hospital of Naval Medical University with CEH-EUS video from March 2013 to April 2020 was retrospectively analyzed.Results:A total of 36 patients were included. There were 16 cases of serous cystadenomas (SCA), 10 cases of mucinous cystic neoplasm (MCN), 5 cases of intraductal papillary mucinous neoplasms (IPMN, 3 with complex type, 2 with main pancreatic duct type) and 5 cases of pancreatic pseudocyst (PPC). 87.5%(14/16) of SCA and 86.7%(13/15) of MCN+ IPMN had hyperenhanced cystic wall with obvious peak and similar washout as surrounding tissue, whereas only 20%(1/5) PPC had hyperenhanced cystic wall. The hyperenhancing effect of PPC was significantly lower than that of SCA and MCN+ IPMN ( P=0.0035 and P=0.0048, respectively ). Mural nodules were detected in 17 cases of pancreatic cystic lesions by EUS, of which 3 cases had hyperenhanced mural modules and 14 cases had hypoenhanced mural nodules by CEH-EUS. Patients showing hyperenhanced mural modules were all finally diagnosed as pancreatic malignancy (1 IPMN, 2 MCN), and the accuracy was 100%. Conclusions:CEH-EUS can have a obvious advantage of differentiating pseudocyst and other pancreatic cystic lesions, while not very useful for differentiating SCA and MCN. Pancreatic cystic lesions showing hyperenhanced mural nodules under CEH-EUS may imply malignancy potential.