超声内镜对消化道黏膜下肿瘤的诊断价值  

Diagnostic value of endoscopic ultrasonography for submucosal tumors of digestive tract

作　　者：查正伟[1] 甘惠中[1] 彭琼[1] 孔德润[2] ZHA Zheng-wei;GAN Hui-zhong;PENG Qiong;KONG De-run(Department of Gastroenterology,the First People's Hospital of Hefei,Hefei,Anhui 230061,China)

机构地区：[1]合肥市第一人民医院消化科,安徽合肥230061 [2]安徽医科大学第一附属医院消化科,安徽合肥230022

出　　处：《中华全科医学》2022年第2期290-293,共4页Chinese Journal of General Practice

基　　金：安徽省重点研究与开发计划项目(1804h08020260)。

摘　　要：目的探讨超声内镜(EUS)对消化道黏膜下肿瘤(SMT)的诊断价值。方法选取合肥市第一人民医院2015年7月-2020年8月收治的SMT患者82例,患者均行EUS检查;根据EUS结果选择不同的手术方式,包括内镜黏膜下剥离术(ESD)、内镜黏膜下挖除术(ESE)、经黏膜下隧道内镜肿瘤切除术(STER)、内镜全层切除术(EFTR)等,比较EUS与病理结果的诊断符合率、根据EUS诊断结果制定的术前方案与实际的手术方案符合率。结果EUS能清晰显示消化道SMT的层次来源、大小、回声、边界;经EUS诊断85例病灶,12例EUS诊断与病理诊断不一致,其中2例食管间质瘤、2例胃间质瘤、1例胃窦血管球瘤、1例副脾、1例神经鞘瘤、1例腺肌瘤、1例纤维瘤误认为平滑肌瘤,2例胃平滑肌瘤、1例胃体异位胰腺均误认为间质瘤,EUS诊断与病理诊断结果符合率为85.9%(73/85);ESD手术40例,ESE手术34例,STER手术2例,EFTR手术9例,其中2例术中转腹腔镜术,术后无出血、穿孔等并发症,根据EUS制定的术前方案与实际的手术方案符合率为97.6%(83/85)。结论EUS是诊断消化道SMT较准确的方法,对内镜下治疗方式的选择有重要指导价值。Objective To explore the value of endoscopic ultrasound(EUS)in the diagnosis of submucosal tumors(SMT)of digestive tract.Methods Total 82 patients with SMT accepted EUS examination and treated at the First People's Hospital of Hefei from July 2015 to August 2020 were recruited.According to EUS results,different surgical methods were choose,including endoscopic submucosal dissection(ESD),endoscopic submucosal excision(ESE),submucosal tunnel endoscopic tumor resection(STER),and endoscopic full-thickness resection(EFTR)etc.The diagnostic coincidence rate between EUS and pathological results,and the coincidence rate between the preoperative plan based on EUS diagnosis and the actual surgical plan were compared.Results EUS could clearly display the layer of origin,size,echo,and the relationship with surrounding tissues of the SMT.Among 85 lesions diagnosed by EUS,12 cases were different from pathological and EUS,including 2 cases of esophageal stromal tumor,2 cases of gastric stromal tumor,1 case of gastric antral hemangioma,1 case of accessory spleen,1 case of schwannoma,1 case of adenomyoma and 1 case of fibroma misdiagnosed as leiomyoma,2 cases gastric leiomyoma and 1 case of gastric ectopic pancreas misdiagnosed as stromal tumors.The coincidence rate of EUS and pathological diagnosis was 85.9%(73/85).There were 40 cases of ESD operation,34 cases of ESE operation,2 cases of STER operation and 9 cases of EFTR operation,of which 2 cases were converted to laparoscopy.There were no complications such as bleeding and perforation after operation.The coincidence rate between the preoperative plan formulated according to EUS and the actual surgical plan was 97.6%(83/85).Conclusion EUS is a highly accurate method to diagnose SMT of digestive tract in the gastrointestinal tract,and has important guiding value for the choice of endoscopic treatment.

关 键 词：超声内镜 消化道黏膜下肿瘤 诊断 

分 类 号：R735[医药卫生—肿瘤] R730.4[医药卫生—临床医学]