超声内镜在中老年上消化道黏膜下层病变的诊断价值
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摘要
目的探索超声内镜在中老年上消化道黏膜下层隆起性病变中的诊断价值。方法选取2014年10月至2017年12月四川省西南医科大学附属医院常规胃镜检查为隆起性病变,同时行超声内镜检查病变来源于黏膜下层228例中老年患者作为研究对象,根据超声内镜扫描病变特征做诊断,以病理诊断为标准,对比病理诊断与超声内镜诊断结果,以此分析超声内镜对黏膜下层病变的诊断价值。结果超声内镜对中老年上消化道黏膜下层病变的诊断准确率为87. 96%,其中病变部位分布为胃92例、十二指肠84例、食管46例、贲门6例;种类包括:平滑肌瘤、间质瘤、囊肿、异位胰腺、脂肪瘤、静脉瘤、纤维瘤、炎症、息肉、神经内分泌瘤,其中以囊肿(69例)最多,其次为脂肪瘤(45例)及异位胰腺(38例),其中有13例误诊。结论超声内镜能清晰观察中老年上消化道黏膜下层病变的回声特性、大小、起源、边界,但存在一定误诊率。
Objective To explore the value of endoscopic ultrasonography( EUS) in the diagnosis of upper gastrointestinal submucosal lesions in the elderly. Methods 228 elderly cases with protuberant lesions by routine gastroscopy in the Affiliated Hospital to Southwest Medical University during the period from Oct.,2014 to Dec.,2017 were selected and the EUS performed at the same time indicated that the lesions were submucosal lesions; a comparison was made between the EUS findings and pathological studies so as to decide the accuracy of EUS in the diagnosis of upper grastrointestinal submucosal lesions.Results The accuracy of EUS in the diagnosis of upper grastrointestinal submucosal lesions was 87. 96%; 92 cases had the lesions in stomach,84 cases in duodenum,46 cases in esophagus and 6 cases in fontanelle; the lesion types included: leiomyoma,stromal tumor,cyst,ectopic pancreas,lipoma,venous tumor,fibroid,inflammation,polyp and neuroendocrine tumor; cysts took up the most part( 69 cases) and then were lipomas( 45 cases) and ectopic pancreatic( 38 cases); misdiagnosis occurred in 13 cases. Conclusions EUS can clearly display the echo characteristics,size,origin and boundary of upper gastrointestinal submucosal lesions while it leads to a certain rate of misdiagnosis.
Objective To explore the value of endoscopic ultrasonography( EUS) in the diagnosis of upper gastrointestinal submucosal lesions in the elderly. Methods 228 elderly cases with protuberant lesions by routine gastroscopy in the Affiliated Hospital to Southwest Medical University during the period from Oct.,2014 to Dec.,2017 were selected and the EUS performed at the same time indicated that the lesions were submucosal lesions; a comparison was made between the EUS findings and pathological studies so as to decide the accuracy of EUS in the diagnosis of upper grastrointestinal submucosal lesions.Results The accuracy of EUS in the diagnosis of upper grastrointestinal submucosal lesions was 87. 96%; 92 cases had the lesions in stomach,84 cases in duodenum,46 cases in esophagus and 6 cases in fontanelle; the lesion types included: leiomyoma,stromal tumor,cyst,ectopic pancreas,lipoma,venous tumor,fibroid,inflammation,polyp and neuroendocrine tumor; cysts took up the most part( 69 cases) and then were lipomas( 45 cases) and ectopic pancreatic( 38 cases); misdiagnosis occurred in 13 cases. Conclusions EUS can clearly display the echo characteristics,size,origin and boundary of upper gastrointestinal submucosal lesions while it leads to a certain rate of misdiagnosis.
引文
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[3]ROSCH T,KAPFER B,WILL U,et al.Acurracy of endoscopic ultrosonography in upper gastrointestinal submucosal lesions:gastrointestinal submucosal lesions:a prospective multicenter study[J].Scand J Gastroenterol,2002,37(7):856-862.
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[6]张志宏,刘晓岗,李良平.超声内镜是否足以精准诊断上消化道黏膜下肿物?[J]胃肠病学和肝病学杂志,2017,26(11):1273-1277.
[7]KANG JH,LIM JS,K IM JH,et al.Role of EUS and MDCT in the diagnosis of gastric submucosal tumors according to the revised pathologic concept of gastrointestinal stromal tumors[J].Eur Radiol,2009,19(4):934-934.
[8]黄士波,张铁民,赵宪琪.胃肠道间质瘤的诊治进展[J].中华临床医师杂志(电子版),2013,7(18):509-512.
[9]SUMIN S,SOO C Y,YOUNG MOG S,et al.Enucleation of esophageal submucosal tumors:a single institution's experience[J].Annals of Thoracic Surgery,2014,97(2):454-459.
[10]曾志勇,黄开红,詹俊,等.上消化道平滑肌肿瘤临床及病理特点[J].广东医学,2003,24(12):1320-1322.
[11]陈保银,马竹芳,刘畅.上消化道黏膜下隆起性病变行微探头超声内镜联合内镜黏膜下剥离术的诊治研究[J].现代消化及介入诊疗,2017,22(5).
[12]TERASAKI M,TANAKA S,OKA S,et al.Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20mm[J].J Gastroenterol Hepatol,2012,27(4):734-740.
[13]DEBOL SM,STANLEY MW,MALLERY S,et al.Glomus tumor of the stomach:cytologic diagnosis by endoscopic ultrasound-guided fineneedle aspiration.Diagn Cytopathol2003;28:316-321[PMID:12768637 DOI:10.1002/dc.10294]
[14]CHAK A.EUS in submucosal tumors[J].Gastrointest Endosc,2002,56(4Suppl):S43-48
[15]TANEMURA A,YANO T,TAMAKI H,et al.Ectopic pancreas in the minor dudodenal papil a presenting as upper-GI bleeding[J].Gastrointest Endosc,2005,62(2):324-326.
[16]卢光荣,叶晓华,陈武杰,等.胃异位胰腺超声内镜误诊为胃间质瘤7例临床分析[J].中华消化内镜杂志,2013,30(3):164-166.
[2]许新芳,毛伯能,吴凌东,等.超声内镜诊断上消化道黏膜下病变临床价值分析[J].北华大学学报(自然科学版),2018,19(1):73-76.
[3]ROSCH T,KAPFER B,WILL U,et al.Acurracy of endoscopic ultrosonography in upper gastrointestinal submucosal lesions:gastrointestinal submucosal lesions:a prospective multicenter study[J].Scand J Gastroenterol,2002,37(7):856-862.
[4]KIM S,HAMERSKI C,GHASSEMI K,et al.The clinical utility of evaluating the luminal upper gastrointestinal tract during linear endoscopic ultrasonography[J].J Clin Gastroenterol,201650(7):538-544.
[5]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.
[6]张志宏,刘晓岗,李良平.超声内镜是否足以精准诊断上消化道黏膜下肿物?[J]胃肠病学和肝病学杂志,2017,26(11):1273-1277.
[7]KANG JH,LIM JS,K IM JH,et al.Role of EUS and MDCT in the diagnosis of gastric submucosal tumors according to the revised pathologic concept of gastrointestinal stromal tumors[J].Eur Radiol,2009,19(4):934-934.
[8]黄士波,张铁民,赵宪琪.胃肠道间质瘤的诊治进展[J].中华临床医师杂志(电子版),2013,7(18):509-512.
[9]SUMIN S,SOO C Y,YOUNG MOG S,et al.Enucleation of esophageal submucosal tumors:a single institution's experience[J].Annals of Thoracic Surgery,2014,97(2):454-459.
[10]曾志勇,黄开红,詹俊,等.上消化道平滑肌肿瘤临床及病理特点[J].广东医学,2003,24(12):1320-1322.
[11]陈保银,马竹芳,刘畅.上消化道黏膜下隆起性病变行微探头超声内镜联合内镜黏膜下剥离术的诊治研究[J].现代消化及介入诊疗,2017,22(5).
[12]TERASAKI M,TANAKA S,OKA S,et al.Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20mm[J].J Gastroenterol Hepatol,2012,27(4):734-740.
[13]DEBOL SM,STANLEY MW,MALLERY S,et al.Glomus tumor of the stomach:cytologic diagnosis by endoscopic ultrasound-guided fineneedle aspiration.Diagn Cytopathol2003;28:316-321[PMID:12768637 DOI:10.1002/dc.10294]
[14]CHAK A.EUS in submucosal tumors[J].Gastrointest Endosc,2002,56(4Suppl):S43-48
[15]TANEMURA A,YANO T,TAMAKI H,et al.Ectopic pancreas in the minor dudodenal papil a presenting as upper-GI bleeding[J].Gastrointest Endosc,2005,62(2):324-326.
[16]卢光荣,叶晓华,陈武杰,等.胃异位胰腺超声内镜误诊为胃间质瘤7例临床分析[J].中华消化内镜杂志,2013,30(3):164-166.