超声内镜在食管结核诊断中的9例应用并文献复习

发布时间：2018-03-02 17:17

本文选题：食管结核　切入点：超声内镜　出处：《中国内镜杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的总结食管结核超声内镜(EUS)声像图特征及其他临床资料结果,提高该病的诊断率。方法回顾性分析该院2011年6月-2016年5月经EUS检查或内镜超声引导下细针穿刺活检(EUS-FNA)而确诊为食管结核的9例患者的临床资料,并复习国内外文献。结果 9例患者中,表现为吞咽梗阻6例,胸骨后疼痛3例,伴有盗汗、低热症状2例,伴咳嗽、咯血1例,伴咽痛1例;病变位于食管中段7例(77.78%),上段1例,食管下段合并咽部病变1例;8例为隆起型病变,其中4例表面破溃,1例呈息肉样隆起,另1例为溃疡并憩室型病变;内镜下活检6例中5例确诊,其中3例活检2次;EUS表现为食管壁内不均质低回声占位,边界模糊,内见高回声光斑,侵及黏膜下层或全层,部分病灶突破外膜层与壁外肿大淋巴结融合贯通;2例行EUS-FNA穿刺,病理发现炎性肉芽肿,考虑结核;均予以抗结核治疗后症状缓解。结论食管结核临床表现主要为吞咽困难,好发于食管中段,内镜下表现主要为隆起型和溃疡型病变,通过多次内镜下活检,结合EUS特征或EUS-FNA穿刺病理学检查能明显提高该病的诊断率,减少误诊率。
[Abstract]:Objective to summarize the ultrasonographic features and other clinical data of esophageal tuberculosis. Methods the clinical data of 9 patients with esophageal tuberculosis diagnosed by EUS or EUS-FNA-guided endoscopic ultrasound from June 2011 to 2016 were retrospectively analyzed. Results there were 6 cases of dysphagia, 3 cases of retrosternal pain, 2 cases of sweating, 2 cases of hypothermia, 1 case of cough, 1 case of hemoptysis and 1 case of pharynx. The lesions were located in the middle part of the esophagus in 7 cases (77.78), the upper segment in 1 case, the lower part of the esophagus with pharynx in 1 case (1 case) as a protruding lesion, in which 4 cases had a polypoid protuberance, the other case was a type of ulcer with diverticular lesion. Among 6 cases of endoscopic biopsy, 5 cases were diagnosed. Among them, 3 cases were diagnosed as hyperechoic mass in the wall of the esophagus, the boundary was blurred, hyperechoic spot was seen in 3 cases, and the submucosa or the whole layer was invaded. Two cases of EUS-FNA puncture were performed to break through the epigastric layer and the extramural enlarged lymph nodes. Inflammatory granuloma was found in pathology, tuberculosis was considered, and symptoms were relieved after anti-tuberculosis treatment. Conclusion the main clinical manifestation of esophageal tuberculosis is dysphagia, and the main clinical manifestation of esophageal tuberculosis is dysphagia. Most of the lesions occurred in the middle part of the esophagus. Endoscopic biopsy combined with EUS features or EUS-FNA biopsy could significantly improve the diagnosis rate and reduce the misdiagnosis rate of the disease.
【作者单位】：湖北民族学院附属民大医院消化内科;
【分类号】：R523

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