内窥镜超声对上消化道黏膜下隆起病变的诊断价值
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摘要
目的探讨内窥镜超声对上消化道黏膜下隆起病变的诊断价值。方法回顾性分析178例经超声内镜检查考虑诊断为上消化道黏膜下隆起,并行手术获得病理结果的病历资料,通过比较EUS诊断及病理结果,评价超声内镜对上消化道黏膜下隆起病变的诊断价值。结果超声内镜诊断上消化道黏膜下隆起性病变的整体符合率为71.9%,常规电子内镜大多数未明确诊断,故超声内镜的诊断准确度明显高于普通内镜;EUS对黏膜下隆起病变的起源层次的整体诊断符合率为91.0%,EUS诊断与病理符合的长宽径和不符合的长宽径比较,均有统计学差异(P<0.01)。结论超声内镜对上消化道黏膜下隆起性病变具有较高的诊断价值。但对于病变体积较小的病灶诊断仍较局限,需定期复查超声内镜观察病灶的变化。EUS对于起源于黏膜下隆起第3、4层的低回声病变的误诊率较高,故在行超声内镜检查时,多点-多方位进行探查,以便找到特征性的声像图,或建议行内镜下手术切除治疗,并行病理检查,同时达到诊断及治疗的效果。
Objective To explore the diagnestic value of endoscopic ultrasonography(EUS)in diagnosis of subepithelial lesions of upper gastrointestinal tract.Methods This was a retrospective study on patients discovered as upper gastrointestinal subepithelial masses by EUS,who were received endoscopic treatment or surgical treatment and had the final pathological results.In the manner of comparing the EUS diagnosis with the pathological diagnosis,to evaluate the diagnostic value of EUS for submucosal lesions of upper gastrointestinal tract,as well as improve the diagnostic consistent rate of EUS.Results Among 178 patients,the total diagnostic consistent rate for submucosal lesions of upper gastrointestinal tract is 71.9%.Most of patients detected by normal endoscopy are not given the definite diagnosis,so the accuracy of EUS was significantly higher than that of electronic endoscope.As to the origin level of submucosal lesion diagnosed by EUS,the total consistent rate is 91.0%.To compare the length-width diameter of lesions which endoscopic ultrasonography was consistent with pathology and that of inconsistent the difference was statistically significant(P<0.01).Conclusions Eus is quite a valuable means for the diagnosis of upper gastrointestinal submucosal lesions,especially for the origin level,EUS has a higher diagnostic value.For hypochoic lesions originating from the mucosa in third or fourth layers are diagnosed by EUS,the misdiagnosis rate is high.For such lesions,it is necessary to carry through multi-point,multi-directional exploration,in order to find the characteristic audio-visual characteristics.So these patients who accepted endoscopic operation,and send the lesions which were resected to pathological examination,so as to achieve the effect of diagnosis and treatment at the same time.
Objective To explore the diagnestic value of endoscopic ultrasonography(EUS)in diagnosis of subepithelial lesions of upper gastrointestinal tract.Methods This was a retrospective study on patients discovered as upper gastrointestinal subepithelial masses by EUS,who were received endoscopic treatment or surgical treatment and had the final pathological results.In the manner of comparing the EUS diagnosis with the pathological diagnosis,to evaluate the diagnostic value of EUS for submucosal lesions of upper gastrointestinal tract,as well as improve the diagnostic consistent rate of EUS.Results Among 178 patients,the total diagnostic consistent rate for submucosal lesions of upper gastrointestinal tract is 71.9%.Most of patients detected by normal endoscopy are not given the definite diagnosis,so the accuracy of EUS was significantly higher than that of electronic endoscope.As to the origin level of submucosal lesion diagnosed by EUS,the total consistent rate is 91.0%.To compare the length-width diameter of lesions which endoscopic ultrasonography was consistent with pathology and that of inconsistent the difference was statistically significant(P<0.01).Conclusions Eus is quite a valuable means for the diagnosis of upper gastrointestinal submucosal lesions,especially for the origin level,EUS has a higher diagnostic value.For hypochoic lesions originating from the mucosa in third or fourth layers are diagnosed by EUS,the misdiagnosis rate is high.For such lesions,it is necessary to carry through multi-point,multi-directional exploration,in order to find the characteristic audio-visual characteristics.So these patients who accepted endoscopic operation,and send the lesions which were resected to pathological examination,so as to achieve the effect of diagnosis and treatment at the same time.
引文
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[7]卢光荣,金健威,蔡振寨,等.早期胃类癌超声内镜下被误诊为胃间质瘤4例及临床分析[J].中国内镜杂志,2015,21(7):767-769.
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[10]秦月花,骆泉,张凯杰.超声内镜对胃脂肪瘤及间质瘤的鉴别诊断价值[J].中国超声医学杂志,2014,30(1):41-44.
[2]邵红征,王桂玲,胡志勇.超声内镜对上消化道隆起病变诊断价值的临床研究[J].现代消化及介入诊疗,2015,20(1):61-63.
[3]郭花,盛剑秋,金鹏,等.超声内镜对消化道黏膜下肿物的诊断价值[J].中华消化内镜杂志,2014,31(9):508-512.
[4] HYUNG-CHUL P,DONG-JUN S,HYUNG-HOON O,et al.Endoscopic ultrasonographic characteristics of gastric schwannoma distinguished from gastrointestinal stromal tumor[J].Korean J Gastroenterol,2015,65(1):21-26.
[5] MA X Y,ZHANG P.One patient with gastric body carcinoid tumor was misdiagnosed by endoscopic ultrasonography[J].Chinese Journal of Ultrasound in Medicine,2014,30(5):480.
[6]卢光荣,符竣惠,钟金伟,等.胃神经鞘瘤超声内镜下被误诊为为间质瘤4例并文献复习[J].中国内镜杂志,2016,22(2):75-78.
[7]卢光荣,金健威,蔡振寨,等.早期胃类癌超声内镜下被误诊为胃间质瘤4例及临床分析[J].中国内镜杂志,2015,21(7):767-769.
[8]高美莹,苗立英,葛辉玉,等.胃间质瘤超声造影表现与良恶性的相关性分析[J].中国超声医学杂志,2017,33(2):184-186.
[9]薛倩,文娟,王晶桐.超声内镜下胃间质瘤的影像特征及随访研究[J].中国超声医学杂志,2015,31(11):991-993.
[10]秦月花,骆泉,张凯杰.超声内镜对胃脂肪瘤及间质瘤的鉴别诊断价值[J].中国超声医学杂志,2014,30(1):41-44.