微型探头超声内镜对消化道隆起性病变诊断价值的研究
发布时间：2018-08-27 07:19
【摘要】：背景:消化道隆起性病变(gastrointestinal eminent lesion)是一类表现为消化道粘膜下隆起或消化道管壁增厚的疾病的统称。超声内镜是目前诊断消化道病变及消化道周围脏器病变的重要诊断方法,对消化道隆起性病变可提供丰富的影像学诊断信息。而微探头超声内镜作为超声内镜的一种类型,其优点是:操作方便,检查与治疗同步完成,减少患者多次进出内镜的痛苦。目的:本课题研究微型探头超声内镜(mEUS)检查术诊断消化道隆起性病变的诊断准确率,总结探讨消化道隆起性病变在mEUS诊断中的超声图像特点,从而全面评价微探头超声内镜对消化道隆起性病变的诊断能力。方法:回顾性分析2011年11月至2015年12月行微探头超声内镜检查术检查消化道隆起性病例302例,所有病例诊断结果均经内镜病理,手术病理或随访确诊,比较微探头超声内镜检查结果及传统内镜检查结果的诊断准确率,数据采用SPSS13.0统计学处理,计数资料采用百分率及构成比描述,组间率比较采用χ2检验,以P0.05为有统计学意义。结果:共有302例患者行微型探头超声内镜检查术,其中上消化道274例,结直肠28例,上消化道中食管97例,胃152例,十二指肠25例。食管隆起性病变mEUS诊断符合率为97.93%(95/97),胃镜诊断符合率为68.04(66/97)。食管隆起性病变97例中平滑肌瘤/间质瘤42例,脂肪瘤7例,囊肿10例,孤立性食管静脉瘤25例,外压性隆起13例。胃内隆起性病变mEUS诊断符合率为94.07%(143/152),胃镜诊断符合率为50.65%(77/152)。胃内隆起性病变共152例,其中胃粘膜增厚性病变15例,包括皮革胃1例、淋巴瘤5例、胃底静脉曲张7例、淋巴细胞性胃炎1例、蔓状血管瘤1例。胃粘膜下隆起性病变137例,包括胃壁外压迫性隆起36例、神经内分泌肿瘤1例、异位胰腺13例、间质瘤/平滑肌瘤75例、血管瘤4例、囊肿4例、纤维瘤1例、脂肪瘤2例、胃肝样腺癌1例。十二指肠隆起性病变mEUS诊断符合率为88%(22/25)),胃镜诊断符合率为68%(17/25)。十二指肠隆起性病变25例中,包括十二指肠脂肪瘤1例、十二指肠间质瘤4例、十二指肠外压性隆起8例、十二指肠囊肿6例、十二指肠神经内分泌肿瘤1例、十二指肠布氏腺瘤1例、十二指肠异位胰腺4例。结直肠性病变mEUS诊断符合率为92.85%(26/28),肠镜诊断符合率为57.14%(16/28)。结直肠隆起性病变共28例,包括结直肠神经内分泌肿瘤3例、结直肠脂肪瘤5例、结直肠间质瘤/平滑肌瘤4例、结直肠子宫内膜异位1例、结直肠囊肿4例、结直肠气囊肿3例、外压性隆起6例、结直肠淋巴瘤2例。结论:微探头超声内镜能清晰的显示消化道管壁各层结构,反映病变的起源层次及浸润深度,因此其能对大多数消化道隆起性病变做出准确诊断。
[Abstract]:Background: (gastrointestinal eminent lesion) is a common term for submucous eminence of digestive tract or thickening of digestive tract wall. Ultrasound endoscopy is an important method for the diagnosis of digestive tract diseases and perialimentary organ diseases, which can provide abundant imaging diagnosis information for digestive tract protuberance lesions. As a type of endoscopic ultrasound, microprobe ultrasound endoscopy has the advantages of convenient operation, simultaneous examination and treatment, and less pain of patients entering and leaving the endoscope many times. Objective: to study the diagnostic accuracy of microprobe endoscopic (mEUS) in the diagnosis of digestive tract protuberance lesions, and to summarize the characteristics of ultrasound images in the diagnosis of digestive tract protuberance lesions in mEUS. Therefore, the diagnostic ability of microprobe endoscopy for digestive tract protuberance was evaluated. Methods: from November 2011 to December 2015, 302 cases of digestive tract protuberance were examined by microprobe endoscopic ultrasonography. All cases were diagnosed by endoscopic pathology, surgical pathology or follow-up. The diagnostic accuracy of microprobe ultrasound endoscopy and traditional endoscopic examination were compared. The data were processed by SPSS13.0 statistics, the counting data were described by percentage and composition ratio, and the rate between groups was analyzed by 蠂 ~ 2 test, with P0.05 as the statistical significance. Results: a total of 302 patients underwent endoscopic microprobe ultrasonography, including 274 cases of upper digestive tract, 28 cases of colorectal cancer, 97 cases of upper digestive tract esophagus, 152 cases of stomach and 25 cases of duodenum. The coincidence rate of mEUS and gastroscopy was 97.93% (95 / 97) and 68.04 (66 / 97) respectively. There were 42 leiomyoma / stromal tumors, 7 lipomas, 10 cysts, 25 solitary esophageal vein tumors and 13 external compression protuberances. The coincidence rate of mEUS and gastroscopy was 94.07% (143 / 152) and 50.65% (77 / 152) respectively. There were 152 cases of intragastric protruding lesions, including 15 cases of thickening lesions of gastric mucosa, including 1 case of leather stomach, 5 cases of lymphoma, 7 cases of varicose gastric fundus, 1 case of lymphocytic gastritis and 1 case of hemangioma. There were 137 cases of submucosal protruding lesions, including 36 cases of extragastric compression, 1 case of neuroendocrine tumor, 13 cases of ectopic pancreas, 75 cases of stromal tumor / leiomyoma, 4 cases of hemangioma, 4 cases of cyst, 1 case of fibroma and 2 cases of lipoma. One case of gastric hepatoid adenocarcinoma. The diagnostic coincidence rate of mEUS was 88% (22 / 25),) for duodenal protruding lesions (68% (17 / 25). Among 25 cases of duodenal protuberance lesions, including 1 case of duodenal lipoma, 4 cases of duodenal stromal tumor, 8 cases of duodenal extrinsic protuberance, 6 cases of duodenal cyst and 1 case of duodenal neuroendocrine tumor. One case of duodenal adenoma and 4 cases of duodenal ectopic pancreas. The coincidence rate of mEUS and colonoscopy was 92.85% (26 / 28) and 57.14% (16 / 28) respectively. There were 28 cases of colorectal neoplasms, including 3 cases of colorectal neuroendocrine tumors, 5 cases of colorectal lipomas, 4 cases of colorectal stromal tumors / leiomyomas, 1 case of colorectal endometriosis and 4 cases of colorectal cysts. There were 3 cases of colorectal gas cyst, 6 cases of external compression protuberance and 2 cases of colorectal lymphoma. Conclusion: microprobe endoscopy can clearly display the structure of digestive tract wall and reflect the level of origin and depth of invasion, so it can make an accurate diagnosis for most of the protruding lesions of the digestive tract.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R57
本文编号：2206529
[Abstract]:Background: (gastrointestinal eminent lesion) is a common term for submucous eminence of digestive tract or thickening of digestive tract wall. Ultrasound endoscopy is an important method for the diagnosis of digestive tract diseases and perialimentary organ diseases, which can provide abundant imaging diagnosis information for digestive tract protuberance lesions. As a type of endoscopic ultrasound, microprobe ultrasound endoscopy has the advantages of convenient operation, simultaneous examination and treatment, and less pain of patients entering and leaving the endoscope many times. Objective: to study the diagnostic accuracy of microprobe endoscopic (mEUS) in the diagnosis of digestive tract protuberance lesions, and to summarize the characteristics of ultrasound images in the diagnosis of digestive tract protuberance lesions in mEUS. Therefore, the diagnostic ability of microprobe endoscopy for digestive tract protuberance was evaluated. Methods: from November 2011 to December 2015, 302 cases of digestive tract protuberance were examined by microprobe endoscopic ultrasonography. All cases were diagnosed by endoscopic pathology, surgical pathology or follow-up. The diagnostic accuracy of microprobe ultrasound endoscopy and traditional endoscopic examination were compared. The data were processed by SPSS13.0 statistics, the counting data were described by percentage and composition ratio, and the rate between groups was analyzed by 蠂 ~ 2 test, with P0.05 as the statistical significance. Results: a total of 302 patients underwent endoscopic microprobe ultrasonography, including 274 cases of upper digestive tract, 28 cases of colorectal cancer, 97 cases of upper digestive tract esophagus, 152 cases of stomach and 25 cases of duodenum. The coincidence rate of mEUS and gastroscopy was 97.93% (95 / 97) and 68.04 (66 / 97) respectively. There were 42 leiomyoma / stromal tumors, 7 lipomas, 10 cysts, 25 solitary esophageal vein tumors and 13 external compression protuberances. The coincidence rate of mEUS and gastroscopy was 94.07% (143 / 152) and 50.65% (77 / 152) respectively. There were 152 cases of intragastric protruding lesions, including 15 cases of thickening lesions of gastric mucosa, including 1 case of leather stomach, 5 cases of lymphoma, 7 cases of varicose gastric fundus, 1 case of lymphocytic gastritis and 1 case of hemangioma. There were 137 cases of submucosal protruding lesions, including 36 cases of extragastric compression, 1 case of neuroendocrine tumor, 13 cases of ectopic pancreas, 75 cases of stromal tumor / leiomyoma, 4 cases of hemangioma, 4 cases of cyst, 1 case of fibroma and 2 cases of lipoma. One case of gastric hepatoid adenocarcinoma. The diagnostic coincidence rate of mEUS was 88% (22 / 25),) for duodenal protruding lesions (68% (17 / 25). Among 25 cases of duodenal protuberance lesions, including 1 case of duodenal lipoma, 4 cases of duodenal stromal tumor, 8 cases of duodenal extrinsic protuberance, 6 cases of duodenal cyst and 1 case of duodenal neuroendocrine tumor. One case of duodenal adenoma and 4 cases of duodenal ectopic pancreas. The coincidence rate of mEUS and colonoscopy was 92.85% (26 / 28) and 57.14% (16 / 28) respectively. There were 28 cases of colorectal neoplasms, including 3 cases of colorectal neuroendocrine tumors, 5 cases of colorectal lipomas, 4 cases of colorectal stromal tumors / leiomyomas, 1 case of colorectal endometriosis and 4 cases of colorectal cysts. There were 3 cases of colorectal gas cyst, 6 cases of external compression protuberance and 2 cases of colorectal lymphoma. Conclusion: microprobe endoscopy can clearly display the structure of digestive tract wall and reflect the level of origin and depth of invasion, so it can make an accurate diagnosis for most of the protruding lesions of the digestive tract.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R57
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