超声内镜对275例上消化道隆起性病变的临床应用分析

发布时间：2018-04-23 05:09

本文选题：超声内镜 + 上消化道隆起性病变　；参考：《皖南医学院》2014年硕士论文

【摘要】：目的：探讨超声内镜（endoscopic ultrasonography，EUS）在上消化道隆起性病变的诊断和治疗中的应用价值，为临床诊疗提供依据。方法：收集2011年1月～2012年12月在弋矶山医院消化内镜中心行胃镜及超声内镜检查发现的上消化道隆起性病变507例，对其中275例患者行活组织检查、EUS-FNA、内镜下切除或手术切除获得病理诊断者纳入本项目研究，比较超声内镜与电子胃镜诊断符合率；并对其中166例患者进一步行CT检查，比较超声内镜与CT诊断符合率；分析超声内镜给出相应诊断的声像图特点，与病理结果作对比，从而归纳出相关病变的超声声像图特征及特点；统计按EUS诊断结果行内镜下治疗或手术治疗患者的治愈率与并发症发生率，进一步评价超声内镜对上消化道隆起性病变治疗方式选择的指导意义。结果：1、超声内镜对上消化道隆起性病变的诊断符合率为88．0%（242/275例），胃镜诊断符合率为57.8%（159/275例），两者诊断一致的符合率为53.5%（147/275例），两者之间的比较应用配对χ2检验，P＜0．01，差异有统计学意义；2、其中，166例患者完成上腹部或胸部CT检查， CT诊诊断符合率为45.2%（75/166例），超声内镜诊断符合率为87.3%（145/166例），两者诊断一致的符合率为39.2%（65/166例），两者之间的比较应用配对χ2检验，P 0．05，差异有统计学意义。2、超声内镜声像特征为：平滑肌瘤表现为均匀低回声，，间质瘤表现为不均匀的低回声，异位胰腺表现为中低回声影，囊肿表现为无回声，脂肪瘤表现为高或强回声，癌表现为稍低回声。3、275例患者，分别行内镜下切除或手术切除，治愈率为98.2％。并发症发生率为2.5％。结论：1、EUS对上消化道隆起性病变的诊断有较高的准确率；2、EUS对上消化道隆起性病变的诊断的准确率明显高于胃镜及CT,对于上消化道隆起病变应首选EUS检查。3、EUS检查病变的声像图特征可以为上消化道隆起性病变的诊断提供较高的价值。4、EUS检查对上消化道隆起性病变治疗方式的选择具有重要的指导意义。
[Abstract]:Objective: to evaluate the value of endoscopic ultrasonography (EUS) in the diagnosis and treatment of upper digestive tract protuberance lesions, and to provide basis for clinical diagnosis and treatment. Methods: from January 2011 to December 2012, 507 cases of upper digestive tract protuberance were examined by endoscopy and gastroscopy in the Center of Digestive Endoscopy in the Gastrointestinal Hospital. Two hundred and seventy-five patients were examined with EUS-FNA.Endoscopic resection or surgical resection for pathological diagnosis was included in the study to compare the diagnostic coincidence rate between endoscopic ultrasonography and electronic gastroscopy, and further CT examination was performed in 166 of them. To compare the coincidence rate of ultrasound endoscopy and CT diagnosis, to analyze the characteristics of ultrasonic image of the corresponding diagnosis, and to compare with the pathological results, so as to sum up the characteristics and characteristics of the ultrasonic image of the related lesions. According to the results of EUS diagnosis, the cure rate and complication rate of patients undergoing endoscopic or surgical treatment were statistically analyzed, and the guiding significance of EUS in the treatment of upper digestive tract protruding lesions was further evaluated. Results the coincidence rate of endoscopic ultrasonography in diagnosis of upper digestive tract protuberance lesions was 88.0 / 242 / 275, gastroscopy was 57.8 / 159 / 275, and the coincidence rate of diagnosis was 53.557 / 275 respectively. The comparison between the two was performed with 蠂 ~ 2 test (P < 0.01), and the difference was significant (P < 0.01). There were 166 cases of upper abdomen or chest CT examination, the coincidence rate of CT diagnosis was 45.2275 / 166 cases, the accuracy rate of endoscopic ultrasonography diagnosis was 87.3% and 145 / 166 cases, the coincidence rate of the two diagnosis was 39.22um / 65166 cases. The comparison between the two cases should be carried out. The pairing 蠂 2 test showed that the difference was statistically significant (P 0.05). The characteristics of endoscopic ultrasonography were as follows: leiomyoma showed homogenous hypoechoic. Stromal tumors showed heterogeneous hypoechoic findings, ectopic pancreas showed low echo, cyst showed anechoic, lipoma showed hyperechoic or hyperechoic, cancer showed slightly hypoechoic. 3275 patients underwent endoscopic resection or surgical resection. The cure rate was 98.2%. The incidence of complications was 2.5. Conclusion the diagnostic accuracy of EUS in the diagnosis of upper digestive tract protuberance lesions is higher than that of gastroscopy and CT.EUS should be selected as the first choice for the diagnosis of upper digestive tract protuberance lesions. 3% EUS is the first choice for the diagnosis of upper digestive tract protuberance lesions. The sonographic features of EUS can provide a high value for the diagnosis of upper digestive tract protuberance lesions. EUS examination has important guiding significance for the choice of treatment methods for upper digestive tract protuberance lesions.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R54

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