对比超声引导下直接活检枪穿刺与同轴针辅助穿刺对胰腺占位性病变的诊断效能，分析2种穿刺方式的安全性及临床应用价值。

回顾性纳入2020年1月至2024年12月在郑州大学第一附属医院接受超声引导下经皮胰腺穿刺活检的患者134例。根据穿刺方式将患者分为直接活检枪组（45例）和同轴针辅助组（89例）。采用倾向性评分匹配方法，以年龄、性别、病灶大小及位置为协变量，以1∶1的比例匹配2组患者，最终纳入直接活检枪组与同轴针辅助组各45例患者。评估2组的技术成功率和病理诊断准确率；记录2组的穿刺数、操作时间、并发症发生率。采用独立样本t检验比较组间穿刺数和操作时间的差异，采用 χ²检验比较组间病理诊断准确率的差异，采用Fisher确切概率法比较组间并发症发生率的差异。

匹配后，2组患者基线资料分布均衡（P均＞0.05）。2组技术成功率均为100%。直接活检枪组和同轴针辅助组的病理诊断准确率均为97.8%（44/45），差异无统计学意义（P＞0.05）。直接活检枪组操作时间、穿刺数显著少于同轴针辅助组[（15.3±3.2）min vs（22.8±4.0 min）、（1.38±0.65）次 vs（2.51±0.98）次]，差异均具有统计学意义（t=9.512、6.437，P均＜0.001）。直接活检枪组并发症发生率为11.1%（5/45），同轴针辅助组为13.3%（6/45），2组患者均无严重并发症发生，差异无统计学意义（P＞0.05）。匹配后队列共诊断恶性肿瘤76例（84.4%），良性病变14例（15.6%）。

超声引导下直接活检枪穿刺诊断胰腺占位性病变安全有效，诊断效能与同轴针辅助穿刺相当，且操作简便，耗时短，可作为胰腺占位性病变穿刺活检的首选方法。

To compare the diagnostic efficacy, safety, and clinical value between direct core needle biopsy and coaxial-assisted biopsy for pancreatic lesions under ultrasound guidance.

This retrospective study enrolled 134 consecutive patients who underwent ultrasound-guided percutaneous pancreatic core needle biopsy at the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2024. The patients were stratified into two groups according to the biopsy approach used: direct biopsy group (n=45) and coaxial needle-assisted biopsy group (n=89). Given the potential for selection bias and imbalanced sample sizes, one-to-one propensity score matching (PSM) was employed to balance baseline characteristics between groups, with age, gender, lesion size, and lesion location serving as matching covariates. After PSM, 45 matched pairs (90 patients in total) were included in the final comparative analysis. Primary outcomes included technical success rate and pathological diagnostic accuracy. Secondary outcomes comprised the number of needle passes, procedure duration, and complication rates. Statistical comparisons were performed using the independent samples t-test for continuous variables and the chi-square test or Fisher's exact test for categorical variables, as appropriate.

After matching, baseline characteristics were well-balanced between groups (all P＞0.05). Both groups achieved a 100% technical success rate. The diagnostic accuracy was 97.8% (44/45) in both groups, showing no significant difference (P＞0.05). The direct biopsy group demonstrated significantly shorter operation time [(15.3±3.2) min vs (22.8±4.0) min] and fewer needle passes [(1.38±0.65) vs (2.51±0.98)] compared with the coaxial-assisted biopsy group (t=9.512 and 6.437, respectively; both P＜0.001). Complication rates were 11.1% (5/45) in the direct biopsy group and 13.3% (6/45) in the coaxial-assisted group, showing no significant difference (P＞0.05). No severe complications occurred in either group. In the matched cohort, 76 cases (84.4%) were diagnosed with malignant tumors and 14 (15.6%) with benign lesions.

This study demonstrates that ultrasound-guided direct core needle biopsy is safe and effective for diagnosing pancreatic lesions, showing comparable diagnostic efficacy to coaxial-assisted biopsy while being simpler to perform and requiring less time. It may be considered as the preferred method for pancreatic lesion biopsy.