超声内镜对结直肠黏膜下病变的诊断价值

发布时间：2018-06-24 09:21

本文选题：超声内镜 + 结直肠黏膜下病灶　；参考：《中国内镜杂志》2017年06期

【摘要】：目的探讨超声内镜(EUS)在结直肠黏膜下病变诊断和治疗中的作用。方法对结直肠黏膜下病变进行EUS检查。根据黏膜下病灶的起源层次,部分患者接受深挖活检、超声内镜引导下细针穿刺吸取活检术(EUS-FNA)、内镜下治疗或外科手术。回顾性分析EUS诊断结果与临床病理的相关性。结果 EUS检查的74例患者中,诊断神经内分泌肿瘤28例(均位于直肠);脂肪瘤15例(其中位于回盲部4例、横结肠1例、升结肠8例、乙状结肠2例);直肠间质瘤2例(固有肌层和黏膜肌层各1例);外压性改变14例(卵巢肿瘤9例,淋巴结2例,盆腔肿瘤3例);囊肿5例(横结肠4例、升结肠1例);气囊肿1例;乙状结肠子宫内膜异位3例;直肠周边恶性肿瘤侵犯4例;肠道淋巴瘤2例。所有病灶均接受深挖活检、EUS-FNA、内镜下治疗或外科手术。最终病理和EUS诊断符合率为68/74(91.9%),其中2例EUS考虑直肠类癌最后病理确诊为黏膜肌层来源的平滑肌瘤。1例考虑脂肪瘤最终确诊为肠道淋巴瘤。2例考虑直肠周边恶性肿瘤最终为炎性包块,1例考虑子宫内膜异位症最终诊断为直肠癌。结论 EUS能清晰地显示消化道各层结构,能清楚显示结直肠黏膜下病变的大小、起源及其与相邻结构的关系,并且能较精确地判断各种病变的性质,进而指导结直肠黏膜下病变的治疗。
[Abstract]:Objective to investigate the role of endoscopic ultrasonography (EUS) in the diagnosis and treatment of colorectal submucosal lesions. Methods EUS was performed on submucosal lesions of colorectal cancer. According to the origin level of submucosal lesions, some patients underwent deep biopsy, endoscopic fine needle aspiration biopsy (EUS-FNA), endoscopic treatment or surgery. The correlation between EUS diagnosis and clinicopathology was analyzed retrospectively. Results of 74 patients with EUS, 28 were diagnosed as neuroendocrine tumors (all located in the rectum), 15 were lipomas (including 4 in ileocecum, 1 in transverse colon, 8 in ascending colon, 4 in ileocecum, 1 in transverse colon and 8 in ascending colon). Two cases of sigmoid colon, 2 cases of rectal stromal tumor (1 case of muscularis propria and 1 case of mucous membrane), 14 cases of external pressure change (9 cases of ovarian tumor, 2 cases of lymph node, 3 cases of pelvic tumor), 5 cases of cyst (4 cases of transverse colon). 1 case of ascending colon; 1 case of gas cyst; 3 cases of endometriosis of sigmoid colon; 4 cases of invading malignant tumor around rectum; 2 cases of intestinal lymphoma. All lesions underwent deep-dug biopsy EUS-FNA. endoscopic treatment or surgery. The coincidence rate between final pathology and EUS diagnosis was 68 / 74 (91.9%), of which 2 cases were considered for rectal carcinoid, including 1 cases of leiomyoma of mucosal myometrium confirmed by final pathology of rectal carcinoid. 1 case of leiomyoma of mucous membrane, considering lipoma. 2 cases of final diagnosis of intestinal lymphoma. 2 cases of malignant tumor around rectum. The final diagnosis of rectal cancer was that the tumor was inflammatory mass in 1 case and endometriosis was considered. Conclusion EUS can clearly display the structures of the digestive tract, the size, origin and the relationship between the submucosal lesions and adjacent structures, and can accurately judge the properties of the lesions. And then guide the treatment of colorectal submucosal lesions.
【作者单位】：苏州大学附属第二医院内镜中心;
【基金】：苏州市科技计划项目(No:SS201641)
【分类号】：R574

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