超声内镜在上消化道黏膜下肿瘤诊治中的临床价值
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摘要
目的探究超声内镜结合微创技术在诊断及治疗上消化道黏膜下肿瘤的应用价值。方法对经电子胃镜发现的156例上消化道黏膜下肿瘤患者行超声内镜检查,其中145例根据超声内镜下病灶情况选择内镜微创治疗或外科手术切除,术后定期随访。结果 156例患者经病理检查确诊145例,其中间质瘤45例。超声内镜诊断黏膜下肿瘤的准确率为86. 9%(126/145),胃良恶性间质瘤的准确率为88. 9%(40/45),来源层次符合率为88. 9%。结论超声内镜在诊断上消化道黏膜下肿瘤具有很高的价值,可以对黏膜下肿瘤来源、部位、性质做出准确的诊断,并为微创内镜下治疗提供重要的影像学依据。
Objective To evaluate the value of endoscopic ultrasonography( EUS) in the diagnosis of upper gastrointestinal submucosal tumors( SMT). Methods 156 cases of upper gastrointestinal SMT were detected by EUS. 145 cases were treated by different theraputic techniques according to the results of EUS. All of the patients were followed upregularly by endoscopy and EUS after treatments. Results 156 cases of upper gastrointestinal SMT diagnosed by EUS including 43 leiomyomas,62 GISTs,18 lipomas,22 etopic pancreases,7 cysts and 4 Neuroendocrine tumors. 121 patients received endoscopic therapy and 24 patients received surgical resection. The diagnostic accuracy of qualitation,GISTs and layer origin of EUS for SMT were 86. 9%,88. 9%,88. 9% respectively. Conclusion EUS is capable of delineating the origin and property of upper gastrointestinal submucosal tumors. It can provide important evidence to manage SMT under endoscopy effectively and safely.
Objective To evaluate the value of endoscopic ultrasonography( EUS) in the diagnosis of upper gastrointestinal submucosal tumors( SMT). Methods 156 cases of upper gastrointestinal SMT were detected by EUS. 145 cases were treated by different theraputic techniques according to the results of EUS. All of the patients were followed upregularly by endoscopy and EUS after treatments. Results 156 cases of upper gastrointestinal SMT diagnosed by EUS including 43 leiomyomas,62 GISTs,18 lipomas,22 etopic pancreases,7 cysts and 4 Neuroendocrine tumors. 121 patients received endoscopic therapy and 24 patients received surgical resection. The diagnostic accuracy of qualitation,GISTs and layer origin of EUS for SMT were 86. 9%,88. 9%,88. 9% respectively. Conclusion EUS is capable of delineating the origin and property of upper gastrointestinal submucosal tumors. It can provide important evidence to manage SMT under endoscopy effectively and safely.
引文
[1]程灿昌.超声内镜对消化道早期癌的诊断价值[J].实用癌症杂志,2016,31(1):114-116.
[2]Kocon P,Szlubowski A,Kuzdzal J,et al.The endosonography-guided needle aspiration in the diagnosis of sarcoidosisrandomized study[J].Pol Arch Med Wewn,2017,56(21):378-384.
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[4]李学彦,郭道光,邵晓东,等.超声内镜检查在上消化道隆起性病变中应用价值[J].临床军医杂志,2016,44(11):1190-1191.
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[13]蒋师,许辉.上消化道间质瘤侵袭危险性的相关因素分析[J].现代肿瘤医学,2015,23(24):3623-3625.
[14]Wang S,Cao H,Zhang Y,et al.Endoscopic submucosal dissection for gastric adenomyoma:a rare entity of 15 cases among 571 patients with gastric submucosal eminence lesions[J].Medicine(Baltimore),2017,96(9):e6233.
[15]王一平,吴俊超.消化道肿瘤的早期诊断与内镜下微创治疗[J].四川大学学报(医学版),2015,46(6):890-895.
[16]陶亚利.内镜超声在消化道肿瘤介入诊治中的进展[J].中国肿瘤,2011,20(12):909-913.
[17]李兆申,邹文斌.如何提高内镜下早期胃癌的诊断水平[J].胃肠病学和肝病学杂志,2016,25(6):601-604.
[18]奚肇宏,田耀洲,梅军,等.小探头超声辅助的内镜黏膜下剥离术治疗上消化道肿瘤性小病变的应用研究[J].中国医师杂志,2014,16(11):1556-1558.
[19]Lee YN,Moon JH,Choi HJ,et al.Diagnostic approach using ERCP-guided transpapillary forceps biopsy or EUS-guided fine-needle aspiration biopsy according to the nature of stricture segment for patients with suspected malignant biliary stricture[J].Cancer Med,2017,11(7):145-152.
[20]Kamata K,Takenaka M,Kitano M,et al.Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of submucosal tumors of the upper gastrointestinal tract[J].J Gastroenterol Hepatol,2017,7(32):67-78.
[2]Kocon P,Szlubowski A,Kuzdzal J,et al.The endosonography-guided needle aspiration in the diagnosis of sarcoidosisrandomized study[J].Pol Arch Med Wewn,2017,56(21):378-384.
[3]邝胜利,李修岭,杨玉秀,等.超声内镜辅助内镜黏膜下剥离术治疗直肠类癌38例分析[J].中华消化内镜杂志,2015,32(1):50-52.
[4]李学彦,郭道光,邵晓东,等.超声内镜检查在上消化道隆起性病变中应用价值[J].临床军医杂志,2016,44(11):1190-1191.
[5]Makmun D,Fauzi A,Shatri H.Sensitivity and specificity of magnetic resonance cholangiopancreatography versus endoscopic ultrasonography against endoscopic retrograde cholangiopancreatography in diagnosing choledocholithiasis:the indonesian experience[J].Clin Endosc,2017,56(3):890-898.
[6]胡文江,向良宏,沈小平.超声内镜联合内镜下黏膜剥离术诊治贲门癌前病变与早期癌症的应用[J].实用临床医药杂志,2015,19(13):83-84,87.
[7]Harada A,Maehata Y,Esaki M.A case of diffuse esophageal leiomyomatosis diagnosed by endoscopic ultrasonography and endoscopic mucosal cutting biopsy[J].Dig Endosc,2017,8(45):456-463.
[8]钟良,徐蔚佳.超声内镜在老年消化道肿瘤中的应用[J].老年医学与保健,2016,22(5):270-273,305.
[9]Rana SS,Chhabra P,Sharma R,et al.Prognostic significance of differentiating necrosis from fluid collection on endoscopic ultrasound in patients with presumed isolated extrapancreatic necrosis[J].Ann Gastroenterol,2017,30(2):232-236.
[10]Da Vee T,Ajani JA,Lee JH.Is endoscopic ultrasound examination necessary in the management of esophageal cancer?[J].World J Gastroenterol,2017,23(5):751-762.
[11]张惠娟,申民强,宋汴敏,等.HRE、EUS联合ESD诊治贲门部癌前病变及早期癌的疗效[J].中国老年学杂志,2013,33(17):4283-4285.
[12]袁德强,史维,赵聪,等.EUS-FNA对上消化道粘膜下及其消化道外邻近占位病变诊断价值的应用探讨[J].四川医学,2008,29(3):309-310.
[13]蒋师,许辉.上消化道间质瘤侵袭危险性的相关因素分析[J].现代肿瘤医学,2015,23(24):3623-3625.
[14]Wang S,Cao H,Zhang Y,et al.Endoscopic submucosal dissection for gastric adenomyoma:a rare entity of 15 cases among 571 patients with gastric submucosal eminence lesions[J].Medicine(Baltimore),2017,96(9):e6233.
[15]王一平,吴俊超.消化道肿瘤的早期诊断与内镜下微创治疗[J].四川大学学报(医学版),2015,46(6):890-895.
[16]陶亚利.内镜超声在消化道肿瘤介入诊治中的进展[J].中国肿瘤,2011,20(12):909-913.
[17]李兆申,邹文斌.如何提高内镜下早期胃癌的诊断水平[J].胃肠病学和肝病学杂志,2016,25(6):601-604.
[18]奚肇宏,田耀洲,梅军,等.小探头超声辅助的内镜黏膜下剥离术治疗上消化道肿瘤性小病变的应用研究[J].中国医师杂志,2014,16(11):1556-1558.
[19]Lee YN,Moon JH,Choi HJ,et al.Diagnostic approach using ERCP-guided transpapillary forceps biopsy or EUS-guided fine-needle aspiration biopsy according to the nature of stricture segment for patients with suspected malignant biliary stricture[J].Cancer Med,2017,11(7):145-152.
[20]Kamata K,Takenaka M,Kitano M,et al.Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of submucosal tumors of the upper gastrointestinal tract[J].J Gastroenterol Hepatol,2017,7(32):67-78.