超声内镜在肠道溃疡性病变的诊断及鉴别诊断价值
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摘要
目的:探讨分析超声内镜在肠道溃疡性病变的诊断及鉴别诊断价值;方法:选取2012年1月-2018年5月本院消化内镜中心确诊的312例肠道溃疡性病变患者,所有患者先行电子肠镜检查,再行超声内镜扫描,分析超声内镜在肠道溃疡性病变的诊断符合率、肠道溃疡性病变在超声内镜下管壁表现、肠道溃疡性病变在超声内镜下管壁特殊声像及管壁外声像。结果:声内镜诊断克罗恩病的灵敏度为91.03%,特异度为93.25%,诊断符合率为93.59%;结直肠淋巴瘤的灵敏度为82.14%,特异度为98.05%,诊断符合率为95.19%;肠道结核的灵敏度为72.73%,特异度为97.49%,诊断符合率为94.87%。超声内镜下克罗恩病患者管壁层次以SM增厚为主占92.38%,M/SM界限、SM/MP界限可辨分别占99.10%、99.85%,主病变回声以稍高回声为主占93.27%,95.07%患者未累及管壁;结直肠淋巴瘤患者层次以层次融合为主占87.50%,M/SM界限、SM/MP界限以消失为主分别占82.14%、80.36%,主病变回声以低回声为主占92.86%,62.50%患者突破管壁,35.71%患者未累及管壁;肠道结核患者层次以M增厚为主占75.76%,M/SM界限、SM/MP界限以可辨为主,分别占90.91%、90.91%,主病变回声以稍高回声为主占87.88%,未累及管壁,占96.97%,各组比较差异均有统计学意义(P<0.05)。超声内镜下克罗恩病管壁特殊声像以铺路石、SM内脉管为主,而结直肠淋巴瘤、肠道结核患者均未出现管壁特殊声像,差异均有统计学意义(P<0.05);肠壁外声像中,克罗恩病、结直肠淋巴瘤、肠道结核淋巴结声像分别占22.87%、53.57%、18.18%,差异均有统计学意义(P<0.05)。结论:超声内镜下可对克罗恩病、肠道淋巴瘤以、肠道肺结核患者的消化道层次做出清晰观察,声像做出鉴别诊断,为临床选择合适的治疗方案提供依据。
Objective:To investigate the value of endoscopic ultrasonography in the diagnosis and differential diagnosis of intestinal ulcer lesions.Method:312 patients with intestinal ulcer disease diagnosed were selected by the Digestive Endoscopy Center of our hospital from January 2012 to May 2018.All patients underwent electronic colonoscopy followed by endoscopic ultrasonography.The diagnostic accuracy of endoscopic ultrasonography in the diagnosis of intestinal ulcer lesions,the appearance of intestinal ulcer lesions under endoscopic ultrasonography,the lesions of intestinal ulcers,the special sound image of the wall under ultrasound endoscopy and the external sound image of the wall of patients were analyzed.Result:The sensitivity of endoscopic diagnosis of Crohn's disease was 91.03%,the specificity was 93.25%;the diagnostic coincidence rate was93.59%,the sensitivity of diagnosis of colorectal lymphoma was 82.14%,the specificity was 98.05%,and the diagnostic coincidence rate was 95.19%;the sensitivity of diagnosis of intestinal tuberculosis was 72.73%,the specificity was 97.49%,and the diagnostic coincidence rate was 94.87%;The endoscopic surface of Crohn's disease patients was dominated by SM thickening,accounting for 92.38%.The/SM limit and the SM/MP limit were99.10% and 99.85%,respectively.The main lesion echo was mainly high echo,accounting for 93.27%,95.07%of the patients did not involve the wall.The colorectal lymphoma patient level was level-fused,the main accounting for 87.50%,the M/SM limit and the SM/MP limit accounted for 82.14% and 80.36%,respectively.The main lesion echo was mainly low echo,accounting for 92.86%,62.50% of patients broke through the wall and 35.71% of patients.The wall of intestinal tuberculosis was mainly affected by M thickening,accounting for 75.76%,the M/SM limit and SM/MP limit were mainly discernible,accounting for 90.91% and 90.91% respectively,the main lesion echo was slightly higher,the echo was dominant accounting for 87.88%,and did not involve the wall accounting for 96.97%.The differences were statistically significant(P<0.05).Under the endoscopic microscope,the special images of Crohn's disease wall were mainly paving stones and SM internal vessels,while the colorectal lymphoma and intestinal tuberculosis patients did not show special images of the wall,the difference was statistically significant(P<0.05);in the external wall of the intestine,the acoustic images of Crohn's disease,colorectal lymphoma and intestinal tuberculosis accounted for 22.87%,53.57% and 18.18% respectively,the differences were statistically significant(P<0.05).Conclusion:Ultrasound endoscopy can make a clear observation of the digestive tract level of patients with Crohn's disease,intestinal lymphoma and intestinal tuberculosis,and the differential diagnosis of sound image can provide a basis for clinical selection of appropriate treatment plan.
Objective:To investigate the value of endoscopic ultrasonography in the diagnosis and differential diagnosis of intestinal ulcer lesions.Method:312 patients with intestinal ulcer disease diagnosed were selected by the Digestive Endoscopy Center of our hospital from January 2012 to May 2018.All patients underwent electronic colonoscopy followed by endoscopic ultrasonography.The diagnostic accuracy of endoscopic ultrasonography in the diagnosis of intestinal ulcer lesions,the appearance of intestinal ulcer lesions under endoscopic ultrasonography,the lesions of intestinal ulcers,the special sound image of the wall under ultrasound endoscopy and the external sound image of the wall of patients were analyzed.Result:The sensitivity of endoscopic diagnosis of Crohn's disease was 91.03%,the specificity was 93.25%;the diagnostic coincidence rate was93.59%,the sensitivity of diagnosis of colorectal lymphoma was 82.14%,the specificity was 98.05%,and the diagnostic coincidence rate was 95.19%;the sensitivity of diagnosis of intestinal tuberculosis was 72.73%,the specificity was 97.49%,and the diagnostic coincidence rate was 94.87%;The endoscopic surface of Crohn's disease patients was dominated by SM thickening,accounting for 92.38%.The/SM limit and the SM/MP limit were99.10% and 99.85%,respectively.The main lesion echo was mainly high echo,accounting for 93.27%,95.07%of the patients did not involve the wall.The colorectal lymphoma patient level was level-fused,the main accounting for 87.50%,the M/SM limit and the SM/MP limit accounted for 82.14% and 80.36%,respectively.The main lesion echo was mainly low echo,accounting for 92.86%,62.50% of patients broke through the wall and 35.71% of patients.The wall of intestinal tuberculosis was mainly affected by M thickening,accounting for 75.76%,the M/SM limit and SM/MP limit were mainly discernible,accounting for 90.91% and 90.91% respectively,the main lesion echo was slightly higher,the echo was dominant accounting for 87.88%,and did not involve the wall accounting for 96.97%.The differences were statistically significant(P<0.05).Under the endoscopic microscope,the special images of Crohn's disease wall were mainly paving stones and SM internal vessels,while the colorectal lymphoma and intestinal tuberculosis patients did not show special images of the wall,the difference was statistically significant(P<0.05);in the external wall of the intestine,the acoustic images of Crohn's disease,colorectal lymphoma and intestinal tuberculosis accounted for 22.87%,53.57% and 18.18% respectively,the differences were statistically significant(P<0.05).Conclusion:Ultrasound endoscopy can make a clear observation of the digestive tract level of patients with Crohn's disease,intestinal lymphoma and intestinal tuberculosis,and the differential diagnosis of sound image can provide a basis for clinical selection of appropriate treatment plan.
引文
[1]杨文宇,梁坚,周宇.超声内镜技术在消化道疾病诊疗中的应用进展[J].海南医学,2018,29(21):3096-3099.
[2]陈豪,刘占举.肠道溃疡性病变的诊断策略[J].医学与哲学(B),2017,38(4):20-22,62.
[3]臧丽丽,赵君.超声内镜在消化道黏膜下肿瘤诊断治疗中的价值[J].中国城乡企业卫生,2019,34(1):111-112.
[4]金震东,李兆申.消化超声内镜学[M].2版.北京:科学出版社,2011:199-355.
[5]綦利平,汪毅,计春燕.小探头超声内镜在消化道狭窄部位的应用[J].临床消化病杂志,2018,30(5):279-282.
[6]陆静静.超声内镜引导下深检术对消化道黏膜下病变的诊治价值研究[J].现代实用医学,2018,30(10):1351-1352,1410.
[7]万承凤,张萍萍,曾炳亮.CT小肠造影对克罗恩病与肠结核的鉴别诊断价值[J].实用临床医学,2018,19(10):66-69,108.
[8]姜志勇,刘福健,李秋琳.超声内镜检查在消化系统疾病诊断中的应用进展[J].右江医学,2016,44(5):594-596.
[9] Varas Lorenzo M J,Maluenda Colomer M D,Barturen B A,et al.Interventional endoscopic ultrasonography[J].Current Treatment Options in Gastroenterology,2014,24(2):77-83.
[10]张春霞,吴小平.克罗恩病的鉴别诊断[J].临床荟萃,2016,31(8):817-819+823.
[11]熊小伟,阳惠湘,彭誉,等.克罗恩病和溃疡性结肠炎食物不耐受的差异分析[J].胃肠病学,2018,23(11):669-672.
[12]尹跃霏,陈亚丽,李赟,等.细胞内镜在炎症性肠病诊治中的应用进展[J].解放军医学杂志,2018,43(11):983-986.
[13]王丹娜,方维丽,李姝,等.上消化道黏膜下病变超声内镜诊断与内镜黏膜下剥离术后病理结果的对比研究[J].中华消化内镜杂志,2016,33(6):367-370.
[14]周维霞,丁科枫,殷国建,等.超声内镜对结直肠黏膜下病变的诊断价值[J].中国内镜杂志,2017,23(6):92-97.
[15]阿布都克尤木江·阿布力孜,艾克拜尔江·吐鲁洪,戴国朝.多层螺旋CT小肠造影在诊断肠结核与克罗恩病中的价值研究[J].影像研究与医学应用,2018,2(19):78-79.
[16]朱惠琼,王双锦,沈凌筠.203例肠结核患者营养状况的调查[J].昆明医科大学学报,2018,39(9):69-72.
[17]陈玲,董秋华.60例肠结核患者临床特征及诊治体会[J].西南国防医药,2018,28(8):758-760.
[18]高翔,常家聪.31例肠结核临床诊断分析[J].中国现代医学杂志,2018,28(22):126-128.
[19]王策,刘欢,王娜,等.PCR技术鉴别肠结核病和克罗恩病的应用及进展[J].国际检验医学杂志,2018,39(7):863-867.
[20]杨志伟,石瑞春.不同炎症性肠病临床特点、肠道内镜及病理的差异[J].中国卫生标准管理,2017,8(27):64-65.
[21]张颖.克罗恩病与肠结核的临床、结肠镜特征分析[J].沈阳医学院学报,2017,19(2):133-135.
[2]陈豪,刘占举.肠道溃疡性病变的诊断策略[J].医学与哲学(B),2017,38(4):20-22,62.
[3]臧丽丽,赵君.超声内镜在消化道黏膜下肿瘤诊断治疗中的价值[J].中国城乡企业卫生,2019,34(1):111-112.
[4]金震东,李兆申.消化超声内镜学[M].2版.北京:科学出版社,2011:199-355.
[5]綦利平,汪毅,计春燕.小探头超声内镜在消化道狭窄部位的应用[J].临床消化病杂志,2018,30(5):279-282.
[6]陆静静.超声内镜引导下深检术对消化道黏膜下病变的诊治价值研究[J].现代实用医学,2018,30(10):1351-1352,1410.
[7]万承凤,张萍萍,曾炳亮.CT小肠造影对克罗恩病与肠结核的鉴别诊断价值[J].实用临床医学,2018,19(10):66-69,108.
[8]姜志勇,刘福健,李秋琳.超声内镜检查在消化系统疾病诊断中的应用进展[J].右江医学,2016,44(5):594-596.
[9] Varas Lorenzo M J,Maluenda Colomer M D,Barturen B A,et al.Interventional endoscopic ultrasonography[J].Current Treatment Options in Gastroenterology,2014,24(2):77-83.
[10]张春霞,吴小平.克罗恩病的鉴别诊断[J].临床荟萃,2016,31(8):817-819+823.
[11]熊小伟,阳惠湘,彭誉,等.克罗恩病和溃疡性结肠炎食物不耐受的差异分析[J].胃肠病学,2018,23(11):669-672.
[12]尹跃霏,陈亚丽,李赟,等.细胞内镜在炎症性肠病诊治中的应用进展[J].解放军医学杂志,2018,43(11):983-986.
[13]王丹娜,方维丽,李姝,等.上消化道黏膜下病变超声内镜诊断与内镜黏膜下剥离术后病理结果的对比研究[J].中华消化内镜杂志,2016,33(6):367-370.
[14]周维霞,丁科枫,殷国建,等.超声内镜对结直肠黏膜下病变的诊断价值[J].中国内镜杂志,2017,23(6):92-97.
[15]阿布都克尤木江·阿布力孜,艾克拜尔江·吐鲁洪,戴国朝.多层螺旋CT小肠造影在诊断肠结核与克罗恩病中的价值研究[J].影像研究与医学应用,2018,2(19):78-79.
[16]朱惠琼,王双锦,沈凌筠.203例肠结核患者营养状况的调查[J].昆明医科大学学报,2018,39(9):69-72.
[17]陈玲,董秋华.60例肠结核患者临床特征及诊治体会[J].西南国防医药,2018,28(8):758-760.
[18]高翔,常家聪.31例肠结核临床诊断分析[J].中国现代医学杂志,2018,28(22):126-128.
[19]王策,刘欢,王娜,等.PCR技术鉴别肠结核病和克罗恩病的应用及进展[J].国际检验医学杂志,2018,39(7):863-867.
[20]杨志伟,石瑞春.不同炎症性肠病临床特点、肠道内镜及病理的差异[J].中国卫生标准管理,2017,8(27):64-65.
[21]张颖.克罗恩病与肠结核的临床、结肠镜特征分析[J].沈阳医学院学报,2017,19(2):133-135.
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