超声内镜对消化道黏膜下肿物的诊断价值  

The diagnostic value of endoscopic ultrasonography for gastrointestinal submucosal tumors

作　　者：郭花[1] 盛剑秋[1] 金鹏[1] 王海红[1] 李娜[1] 赵晓军[1] 

机构地区：[1]北京军区总医院消化科,北京100700

出　　处：《中华消化内镜杂志》2014年第9期508-512,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价超声内镜对消化道黏膜下肿物（SMT）的诊断价值。方法对378例胃肠镜检查过程中发现SMT的患者进一步行超声内镜检查，记录超声内镜下病变的形状、数量、起源层次，并对病变进行定性诊断。根据肿物切除术中实际所见统计超声内镜判断SMT形状、数量、起源层次的符合率，以切除标本病理学及免疫组织化学检查结果为金标准检验超声内镜定性诊断SMT的符合率。结果378例SMT中，平滑肌瘤（131例）最多见，多为低回声（87例）、回声均匀（119例）、起源于黏膜肌层（92例）；其次为胃肠道间质瘤（111例），多为低回声（51例）或中低回声（51例）、回声均匀（78例）、起源于固有肌层（85例）；再次为类癌（50例），内部回声均匀，多为低回声（36例）、起源于黏膜下层（27例）；还发现脂肪瘤45例，起源于黏膜下层，多为高回声（40例）、回声均匀（41例）；异位胰腺（19例）、神经鞘瘤（4例）、颗粒细胞瘤（4例）等相对少见。超声内镜对SMT的总体定性诊断符合率为78．6％（297／378），瘤体的形状判断符合率为91．8％（347／378），数量判断符合率为95．5％（361／378），层次起源判断符合率为96．8％（366／378）。结论各种SMT在超声内镜下特点不一，虽然超声内镜检查可以显示肿物的回声、大小、起源以及与消化道管壁层次的关系，对于SMT的诊断、鉴别诊断及治疗方案的选择有重要的指导意义，但是仍有一定局限性。Objective To investigate the diagnostic value of endoscopic ultrasonography （EUS） for gastrointestinal submucosal tumors. Methods EUS was performed on 378 patients with submucosal tumor detected by endoscopy. The shape, number,origin, and property were recorded under endoscopic uhrasonogra- phy. The diagnostic consistent rate was calculated with pathology as the golden standard. Results Among 378 patients, there were 131 cases of gastrointestinal leiomyoma, mostly low echo （n = 87 ）, homogeneous echo （n = 119）, and originated from muscular layer of mueosa （n = 92 ）. There were 111 cases of gastrointestinal stromal tumor, mainly low echo （ n = 51 ）, medium low echo （ n = 51 ）, homogeneous echo （ n = 78 ）, originated from muscnlaris propria（ n = 85 ）. There were also 50 cases of carcinoid tumor, mainly low echo （n = 36 ）, originated from submueosa （ n = 27）. Forty-five cases of lipoma were detected, also originated from submuco- sa, mainly hyperecho （ n = 40）, homogeneous echo （ n = 41 ）. Heterotopic pancreas （ n = 19 ）, schwannoma （n =4）, and granular cell tumor （n =4） were relatively rare. Overall diagnostic consistent rate of EUS in submucosal tumor was 78.6% （297/378）, diagnostic consistent rate of the shape of the tumor was 9l. 8% （347/378）, diagnostic consistent rate of the number was 95.5% （361/378） , and the consistent rate of origin was 96. 8% （366/378）. Conclusion All kinds of submucosal tumor have certain features under endoscopic uhrasonography. Endoscopic ultrasonography can display echo, size, origin of gastrointestinal submucosal tumors, as well as their relations with the wall layer in gastrointestinal tract. It plays an important role in the diagnosis, differential diagnosis and treatment options, but there are still some limitations.

关 键 词：内镜超声检查术 消化道黏膜下肿物 

分 类 号：R735[医药卫生—肿瘤]