超声内镜对270例上消化道黏膜下肿物的诊断价值

发布时间：2018-12-28 11:40

【摘要】：目的:探讨上消化道粘膜下肿物(SMT)各类型病变的好发部位、在超声内镜(EUS)下的表现;通过结合内镜下治疗及术后病理诊断,探讨EUS对各种类型的SMT的诊断方面的价值,以及对此类病变的内镜下治疗的指导作用。方法:选取2012年01月01日至2016年12月31日在广西医科大学第一附属医院行普通胃镜检查诊断为上消化道黏膜下肿物,并行超声内镜检查的患者270例作为研究对象,收集患者一般信息(姓名、性别、年龄、检查日期、联系电话等)、超声内镜检查结果(病变部位、来源层次、回声特点)、是否行内镜下治疗或外科手术、治疗相关记录、术后病理结果。结果:1、上消化道黏膜下肿物病变特点分析:本组270例SMT患者中,病变位于食管的有108例,占总例数40.00%,病变位于贲门的有5例,占总例数1.85%,病变位于胃内145例,占总数的53.70%,12例的病灶位置在十二指肠,占总例数4.44%。黏膜肌层、固有肌层是食管病变的大部分来源,病变主要类型为平滑肌瘤;胃部病变主要来源于黏膜下层、固有肌层,病变主要类型为间质瘤、异位胰腺。平滑肌瘤病变常见回声表现为均匀、低回声团块,常见来源于黏膜肌层及固有肌层;间质瘤的常见回声表现为均匀、低回声团块,常见来源于固有肌层;异位胰腺其常见回声表现为不均匀、低回声团块,常见来源于黏膜下层。2、上消化道黏膜下肿物病变治疗及病理诊断分析:本组270例SMT患者中,有45例行内镜下黏膜切除术(EMR),54例行内镜下黏膜剥离术(ESD),3例行内镜经黏膜下隧道肿瘤切除术(STER)。其中67例上消化道黏膜下肿物大小小于1cm,38例上消化道黏膜下肿物大小为1～3cm。EMR术中并发出血1例(占2.22%),ESD术中并发出血1例(占1.850%),穿孔5例(占9.26%)。本组病例通过对比超声内镜诊断及病理诊断,89.06%的上消化道平滑肌瘤病例的EUS诊断与病理诊断相符,对于上消化道间质瘤的EUS诊断的符合率53.13%,对于上消化道异位胰腺的EUS诊断的符合率52.63%。本组病例中通过病理诊断为炎症14例,神经内分泌癌1例,癌前病变4例,上述病例的EUS诊断与病理诊断不符。结论:1.超声内镜可通过探查上消化道黏膜下肿物病变部位、病变大小、来源层次、回声高低、回声是否均匀等,对病变作出超声内镜诊断并为内镜下治疗方案的选择提供指导。2.在上消化道黏膜下肿物病变类型诊断方面,超声内镜诊断与病理诊断符合率达72.88%,但超声内镜对于诊断上消化道黏膜下炎症、癌前病变、恶性肿瘤有一定局限性。
[Abstract]:Objective: to investigate the location of various types of (SMT) lesions in upper digestive tract submucosal tumor and the features of the lesions under endoscopic (EUS) (EUS). Combined with endoscopic therapy and postoperative pathological diagnosis, the value of EUS in the diagnosis of various types of SMT and its guiding role in endoscopic treatment of these diseases were discussed. Methods: from January 01, 2012 to December 31, 2016, 270 patients with upper digestive tract submucosal tumor diagnosed by general gastroscopy in the first affiliated Hospital of Guangxi Medical University were selected as study subjects. Collect general information of patients (name, sex, age, date of examination, contact number, etc.), results of endoscopic ultrasonography (location of lesion, level of origin, echo characteristics), whether or not endoscopic treatment or surgery, treatment related records, Postoperative pathological results. Results: 1. Analysis of the characteristics of upper digestive tract submucosal lesions: of the 270 cases of SMT, 108 cases were located in the esophagus, accounting for the total number of cases, and 5 cases were located in the cardia, accounting for 1.85% of the total cases. The lesions were located in the duodenum in 145 cases, accounting for 53.70% of the total. The lesions were located in the duodenum (4.44%). The mucosal myometrium and muscularis propria are the major sources of esophageal lesions, the main types of lesions are leiomyoma, and the gastric lesions are mainly derived from the submucosal layer, the lamina propria muscularis, and the main types of lesions are stromal tumors and ectopic pancreas. The echo of leiomyoma was homogenous, low echoic mass, usually originated from mucosal myometrium and propria myometrium, and the common echo of stromal tumor was homogenous, hypoechoic mass, and common origin from lamina propria muscularis. In ectopic pancreas, the common echogenic features were heterogeneity, hypoechoic mass and submucosal mass. 2. The treatment and pathological diagnosis of submucosal lesions of upper digestive tract: in this group of 270 cases of SMT, There were 45 cases of endoscopic mucosal resection (EMR), 54 cases of endoscopic mucosal dissection (ESD), 3 cases of endoscopic submucosal tunnel tumor resection (STER). In the 67 cases, the size of submucosal tumor of upper digestive tract was less than 1 cm ~ (-1). The size of the tumor of upper digestive tract was 1 case during 1~3cm.EMR (2.22%), 1 case (1.85%) complicated with hemorrhage during), ESD. Perforation occurred in 5 cases (9.26%). By contrast with endoscopic and pathological diagnosis, 89.06% of the patients with upper gastrointestinal leiomyoma were diagnosed by EUS, and 53.13% of the upper gastrointestinal stromal tumors were diagnosed by EUS. The coincidence rate of EUS diagnosis for ectopic pancreas of upper digestive tract was 52.63. In this group, 14 cases of inflammation, 1 case of neuroendocrine carcinoma and 4 cases of precancerous lesion were diagnosed by pathology. The EUS diagnosis of the above cases was not consistent with the pathological diagnosis. Conclusion: 1. Ultrasound endoscopy can provide guidance for endoscopic diagnosis of upper gastrointestinal tract submucosal tumor by exploring lesion location, lesion size, origin level, echo homogeneity and so on. 2. In the diagnosis of submucosal lesions of upper digestive tract, the coincidence rate between endoscopic and pathological diagnosis is 72.88. However, endoscopic ultrasonography has some limitations in the diagnosis of upper gastrointestinal submucosal inflammation, precancerous lesions and malignant tumors.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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