高频超声内镜鉴别上消化道黏膜内癌及黏膜下癌  

Ultrasonic endoscopy in differentiating intramucosal carcinoma from submucosal carcinoma in the upper gastrointestinal tract

作　　者：武育卫[1] 彭贵勇[1] 龙庆林[1] 陈磊[1] 李向红[1] 

机构地区：[1]第三军医大学西南医院全军消化病研究所,重庆400038

出　　处：《第三军医大学学报》2009年第16期1535-1538,共4页Journal of Third Military Medical University

基　　金：重庆市科技攻关项目(2008AC5003)~~

摘　　要：目的探讨高频超声内镜鉴别上消化道黏膜内癌及黏膜下癌的价值。方法129例上消化道早期癌患者术前行高频超声内镜检查,分析上皮内癌、黏膜肌层癌、黏膜下癌的超声影像学特征。34例行内镜下黏膜切除术,5例行内镜下黏膜下剥离术,90例行外科手术。术后标本行病理学检查确定其浸润深度。结果高频超声内镜显示上皮内癌30例,黏膜上皮层增厚,黏膜肌层形态规则;黏膜肌层癌42例,36例黏膜层及黏膜肌层增厚,两层界限不清楚,黏膜下层形态规则,6例黏膜层及黏膜肌层增厚,黏膜下层部分稍增厚,形态规则;黏膜下癌57例,黏膜下层形态改变,变细8例,增粗6例,扭曲5例,不规则10例,部分中断12例,与黏膜肌层分界不清楚16例,固有肌层形态规则。术后病理:黏膜内癌78例,黏膜下癌51例。高频超声内镜判断黏膜内癌特异性为92.2%(47/51),敏感性为87.2%(68/78),黏膜下癌特异性为87.2%(68/78),敏感性为92.2%(47/51),其鉴别黏膜内癌及黏膜下癌准确性为89.1%(115/129)。结论高频超声内镜能较准确鉴别上消化道黏膜内癌及黏膜下癌。Objective To explore the value of ultrasonic endoscopy in discriminating intramucosal carcinoma from submucosal carcinoma in the upper gastrointestinal tract. Methods Preoperative ultrasonic endoscopy was performed in 129 eases with early cancers of the upper gastrointestinal tract. The ultrasonographic images of intraepithelial carcinoma, muscularis mucosae carcinoma, and submucosal carcinoma were analyzed. Endoscopic mucosal resection, endoscopic submueosal dissection, and surgical operation were performed in 34, 5, and 90 cases, respectively. The infiltration depth of early Results Ultrasonic endoscopy revealed intraepithelial lamina and regular morphology of muscularis mucosae, cancers was confirmed pathologically after operation. carcinoma in 30 cases with thickened mucosa epithelial muscularis mucosae carcinoma in 36 cases with thickened mucosa and muscularis mucosae unclear demarcation but regular morphology of submucosa, muscularis mucosae carcinoma in 6 cases with partially thickened submucosa but regular morphology, submucosal carcinoma in 57 cases with changed submucosal morphology （thinned in 8 cases, thickened in 6 cases, twisted in 5 cases, irregular in 10 cases partially discontinued in 12 cases, and unclear of muscularis mucosae and submucosa ambit in 16 cases）. Pathological examination after treatment reported 78 cases of intramucosal carcinoma and 51 cases of submucosal carcinoma. The specificity and sensibility in intramucosal carcinoma by ultrasonic endoscopy were 92.2% （47/51） and 87.2% （68/78） while in submucosal carcinoma were 87.2% （68/78） and 92.2% （47/51）. The diagnostic accuracy in differentiating intramucosal carcinoma from submucosal carcinoma by ultrasonic endoscopy was 89.1% （115/129）. Conclusion Ultrasonic endoscopy is effective in differentiating intramucosal carcinoma from submueosal carcinoma in the upper gastrointestinal tract.

关 键 词：超声内镜 上消化道 黏膜内癌 黏膜下癌 

分 类 号：R446.8[医药卫生—诊断学] R730.41[医药卫生—临床医学]