超声内镜联合凿洞式活检对皮革胃的临床诊断价值研究  

Study on the clinical application of the combination of endoscopic ultrasonography and chiseled biopsy for linitis plastica

作　　者：程吉云[1] 余贤恩[1] 黄培宁[1] 韦凯扬[1] 覃敏珍[1] CHENG Ji-yun;YU Xian-en;HUANG Pei-ning(Digestive Department,People's Hospital of Baise,Baise 533000,China.)

机构地区：[1]百色市人民医院消化科,广西百色533000

出　　处：《中国医学装备》2021年第4期101-104,共4页China Medical Equipment

基　　金：百色市科学研究与技术开发计划(150703)“超声内镜联合凿洞式活检在部分胃内深层病变中的临床应用研究”。

摘　　要：目的:探讨超声内镜联合凿洞式活检对皮革胃的临床诊断价值。方法:选取医院收治的86例疑似皮革胃患者,所有患者先行胃镜活检,再行超声内镜联合凿洞式活检,以手术组织病理确诊的结果作为标准,比较胃镜活检、超声内镜联合凿洞式活检对皮革胃的诊断价值。结果:86例皮革胃患者中病变部位位于胃窦部12例,胃体部20例,胃窦、体17例,胃体、底23例,累及全胃14例。在超声内镜下病变处胃壁表现为不同程度的增厚(7.5~21.3 mm),平均增厚(16.41±4.18)mm,胃壁层次结构比较模糊或者消失。86例疑似皮革胃患者中18例病灶侵犯至黏膜下层,38例病灶侵犯至固有肌层,30例病灶侵犯至浆膜层。86例疑似皮革胃患者中均匀低回声49例,不均匀低回声21例,中等回声改变16例。弹性成像主要以蓝色为主,弹性应变率为44~81。超声内镜发现胃周淋巴结转移8例,腹水18例。86例疑似皮革胃患者经过病理检查确诊,其中80例为皮革胃,4例为胃平滑肌,2例为原发性胃肠淋巴瘤。以病理检查结果为标准,超声内镜联合凿洞式活检对皮革胃的检出灵敏度为91.25%,显著高于胃镜活检的38.75%,差异有统计学意义(x^(2)=48.462,P<0.05),特异度为66.67%,高于胃镜活检的33.33%,但差异无统计学意义;误诊率为33.33%低于胃镜活检的66.67%,但差异无统计学意义,漏诊率为8.75%低于胃镜活检的61.25%,差异有统计学意义(x^(2)=10.895,P<0.05);诊断符合率为87.21%高于胃镜活检的43.02%,差异有统计学意义(x^(2)=36.960,P<0.001)。结论:相比于胃镜活检,超声内镜联合凿洞式活检有助于获得黏膜下层病变组织,显著提高皮革胃的诊断阳性率,与病理诊断符合率高,且该操作创伤小、安全性高。Objective:To explore the clinical diagnostic value of the combination of endoscopic ultrasonography and chiseled biopsy for linitis plastica.Methods:A retrospective analysis of 86 clinical data of patients with suspected linitis plastica admitted to hospital was performed.All patients underwent gastroscopy biopsy followed by endoscopic ultrasonography combined with chisel biopsy.The results of surgical histopathological diagnosis were used as the standard to compare the diagnostic value of gastroscopic biopsy and endoscopic ultrasonography combined with chiseled biopsy for the linitis plastica.Results:Among the 86 patients with linitis plastica,the diseased site of 12 cases located in the antrum of stomach,and that of 20 cases located in the body of stomach,and that of 17 cases located in the antrum and body of stomach,and that of 23 cases located in the body and bottom of stomach,and 14 cases involved in the whole stomach.Under the endoscopic ultrasonography,the gastric wall on the lesion showed thickening with different degrees(7.5~21.3 mm),average value was(16.41±4.18)mm,and the gastrointestinal hierarchical structure of the stomach wall was blurred or disappeared.Among them,the lesions of 18 cases(20.93%)invaded in the submucosa,and that of 38 cases(44.19%)invaded in the muscularis propria and that of 30 cases(34.88%)invaded in the serosal layer.There were 49 cases(56.98%)with uniform hypoechoic,21 cases(24.42%)with uneven hypoechoic,and 16 cases(18.60%)with moderate echo in 86 cases with suspected limitis plastica.Elastography was mainly blue,and the elastic strain rate was 44~81.Endoscopic ultrasonography revealed 8 cases(9.30%)were perigastric lymph node metastasis and 18 cases(20.93%)were ascites.After 86 patients with suspected linitis plastica were confirmed by pathological examination,80 cases were linitis plastica,and 4 cases were gastric smooth muscle,and 2 cases were primary gastrointestinal lymphoma.As the results of pathological examination that was taken as the standard,the sensitivity of detect

关 键 词：超声内镜 凿洞式活检 胃镜活检 皮革胃 诊断价值 

分 类 号：R445.1[医药卫生—影像医学与核医学]