纵隔及腹腔恶性淋巴结的超声内镜声像图特征分析  

Endoscopic ultrasonography features of malignant mediastinal and abdominal lymphadenopathy

作　　者：张奕蕊 朱建伟 胡端敏[1] 杨琳 吴伟[1] 徐丽明[1] 徐龙江[1] 程桂莲[1] Zhang Yirui;Zhu Jianwei;Hu Duanmin;Yang Lin;Wu Wei;Xu Liming;Xu Longjiang;Cheng Guilian(Department of Gastroenterology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院消化科,苏州215004

出　　处：《中华消化内镜杂志》2022年第4期307-312,共6页Chinese Journal of Digestive Endoscopy

基　　金：苏州市临床重点病种诊疗技术专项(LCZX201707);姑苏卫生人才培养项目(GSWS2019012)。

摘　　要：目的探讨超声内镜预测纵隔及腹腔恶性淋巴结的声像图特征,以期为精准施行内镜超声引导下细针穿刺抽吸术(endoscopic ultrasonography-guided fine-needle aspiraiton,EUS-FNA)提供更多依据。方法2016年9月一2021年2月间,因纵隔或腹腔淋巴结肿大,在苏州大学附属第二医院消化科行内镜超声检查,经EUS-FNA病理和(或)外科手术病理及至少6个月随访明确淋巴结良恶性质的83例连续病例纳入病例对照研究,根据最终诊断结果分为恶性淋巴结组(n=56)和良性淋巴结组(n=27),采用单因素分析和多因素Logistic回归分析方法,分析超声内镜下恶性淋巴结声像图特征方面的独立危险因素。结果单因素分析发现组间比较P<0.10的指标有淋巴结短轴长度、短长轴长度比、形态构成、边界是否清晰、淋巴门是否消失、回声是否均一、生长方式构成。多因素Logistic回归分析结果显示,短轴长度>10 mm(P=0.021,OR=9.751,95%CI:1.407~57.573)、边界清晰(P=0.009,OR=20.587,95%CI:2.149~197.251)、淋巴门消失(P=0.019,OR=28.502,95%CI:1.725~470.864)、簇状聚集生长方式(P=0.004,OR=45.539,95%CI:3.429-604.822)、部分融合生长方式(P=0.004,OR=50.012,95%CI:3.497~715.266)是超声内镜预测纵隔及腹腔恶性淋巴结的独立危险因素。结论内镜超声检查有助于鉴别纵隔及腹腔良恶性淋巴结,超声内镜下淋巴结具有短轴长度>10 mm、边界清晰、淋巴门消失、簇状聚集或部分融合生长方式的特征时提示恶性可能性大,应优先行EUS-FNA。Objective To investigate the features of endoscopic ultrasonography in the diagnosis of malignant mediastinal and abdominal lymphadenopathy and to provide more evidence for endoscopic ultrasound-guided fine-needle aspiraiton(EUS-FNA).Methods A case-control study was performed on 83 consecutive patients who underwent EUS in the Second Affiliated Hospital of Soochow University from September 2016 to February 2021.Lymph node properties were identified by pathological results of EUS-FNA and(or)surgery and follow-up for at least 6 months.According to the final diagnosis,patients were divided into malignant lymph node group(n=56)and benign lymph node group(n=27).Univariate analysis and multivariate logistic analysis were performed to identify independent risk factors for malignant lymphadenopathy in terms of EUS features.Results Univariate analysis showed that the length of short axis,short-long axis ratio,shape,border,presence or absence of hilum,heterogencous echo,and the growth pattern of lymph node were risk factors for malignant lymph nodes(P<0.10).Mulivariate logistic regression analysis showed that short axis>10 mm(P=0.021,OR=9.751,95%CI:1.407-57.573),clear border(P=0.009,0R=20.587,95%CI:2.149-197.251),absence of hilum(P=0.019,OR=28.502,95%CI:1.725-470.864),nodal matting(P=0.004,OR=45.539.95%CI:3.429-604.822),partial nodal fusion(P=0.004.OR=50.012,95%CI:3.497-715.266)were independent risk factors for malignant mediastinal and abdominal lymph nodes.Conclusion EUS is useful to differentiate the lymph node properties in the mediastinal or abdominal cavity.Short axis>10 mm,clear border,absence of hilum,nodal matting and partial nodal fusion are high-risk EUS features of malignant mediastinal or abdominal lymphadenopathy,where priority should be given to EUS-FNA.

关 键 词：淋巴结 恶性淋巴结 纵隔及腹腔 内镜超声检查 内镜超声引导下细针穿刺抽吸术 

分 类 号：R730.44[医药卫生—肿瘤]