直肠类癌的内镜超声诊断和内镜黏膜下切除

目的 研究内镜超声对直肠类癌的诊断价值，探讨内镜下黏膜切除术治疗直肠类癌的应用价值。方法 应用微超声探头对结肠镜发现的黏膜正常的大肠隆起性病灶进行超声检查，对诊断直肠类癌病例应用套扎器对准病灶负压吸引进行圈套结扎，再在皮圈根部连皮圈电切病灶。比较内镜超声诊断和病理检查结果，观察切除标本基底有无肿瘤累及。结果 126例黏膜正常的大肠隆起性病灶经内镜超声诊断，25例直肠类癌全部得到病理证实。直肠类癌表现为黏膜下层的边界清晰、回声欠均匀的低回声肿块。全部类癌病例无固有肌层和血管浸润，行内镜黏膜下切除无一例出现出血和穿孔，切除标本边缘和基底无肿瘤累及。结论 内镜超声可以明确直肠类癌的肠壁来源、大小、内部回声性质、边界、有无肌层和周围血管浸润，内镜下黏膜切除术治疗直肠类癌疗效确切。     

经肠镜微探头超声检查对结直肠黏膜下隆起病灶的诊断分析

目的 探讨经内镜微探头超声检查对结直肠黏膜下隆起病灶的诊断价值.方法 应用微探头对68例70处结直肠黏膜下隆起性病灶进行肠镜下超声检查,总结内镜超声特点,并与最终诊断比较.结果 发现类癌20例,表现为黏膜下层低回声;脂肪瘤12例,多位于右半结肠(11/12),表现为黏膜下层、边界清楚的强回声;囊肿12例,表现为黏膜下层的单房或多房性的无回声区,包膜完整;间质瘤或平滑肌瘤12例,多位于直肠9例,表现为黏膜肌层及以下各层次的均匀或不均匀低回声为主,外覆稍强回声包膜,两者在超声下很难区别;恶性淋巴瘤3例5个,表现为局部黏膜肌层和黏膜下层增厚,呈中低回声,不均匀,较少侵及固有肌层;血管性病变(血管瘤、静脉曲张)3个,表现为黏膜及黏膜下层的无回声,部分中、高回声,圆形或不规则形,散在或成族状分布,部分互相沟通;另外,还有子宫内膜异位2例,色素沉积1例,阑尾慢性脓肿1例,壁外压迫2例.超声与最终诊断结果均相符.结论 经内镜微探头超声检查可以明确大肠黏膜下隆起的大小、肠壁起源和边界.根据超声特征对黏膜下良恶性判别有一定的价值,同时能与腔外压迫性病变相鉴别.     

胃镜及内镜超声在食管乳头状瘤诊治中的价值

目的:探讨胃镜及内镜超声在食管乳头状瘤(esophageal papillomas,EP)诊治中的价值.方法:我院消化内镜中心2003-07/2008-10经内镜电切或活检标本病理证实EP患者49例,均行胃镜检查,其中24例行内镜超声检查,分析其常规胃镜表现、内镜超声声像图特征及其与病理和临床的关系.结果:49例行胃镜检查的EP病例多位于食管中下段(占89.8%),呈羽毛状或乳头状隆起,表面呈絮状或细颗粒状,色灰白,多为单发,大小0.3-0.6 cm;24例行超声内镜检查的EP患者中有17例EUS诊断为食管乳头状瘤(占70.8%),6例EUS诊断为炎性增生或息肉(25%);其典型EUS声像图特征为起源于黏膜层的均匀等回声,边界清晰,向腔内突出.结论:EUS能清晰显示EP起源层次和侵犯深度,可用于判断其是否适合内镜下治疗.     

内镜超声对消化道黏膜下肿瘤内镜术前评估的价值和局限性

目的探讨内镜超声检查术（EUS）对消化道黏膜下肿瘤（SMT）层次来源与性质的诊断能力及局限性。方法2016年1月至2018年12月，收治于上海交通大学医学院附属瑞金医院消化科，术前EUS诊断为消化道SMT，接受内镜下切除术治疗，术后病理资料完整的211例病例纳入回顾性研究，以手术病理为参照，分析术前EUS诊断SMT的准确率以及EUS对SMT的诊断局限性。结果病灶位于食管66例、胃108例、十二指肠2例、直肠35例。EUS对病变层次来源的诊断准确率达99.5%（210/211）。就病变性质而言，160例EUS诊断准确（75.8%，160/211）。就不同部位的病变而言，EUS对食管黏膜-黏膜下层来源、食管固有肌层来源、胃黏膜-黏膜下层来源、胃固有肌层来源、十二指肠黏膜下层来源、直肠黏膜-黏膜下层来源病变的诊断准确率分别为90.0%（54/60）、83.3%（5/6）、31.0%（13/42）、89.4%（59/66）、50.0%（1/2）、82.9%（29/35）。对于EUS显示为低回声为主的病变，平滑肌瘤、平滑肌瘤/胃肠间质瘤、神经内分泌肿瘤分别是食管黏膜来源、消化道固有肌层来源和直肠黏膜-黏膜下层来源病变的较常见肿瘤类型。结论尽管EUS对消化道SMT的诊断具有不可替代的重要作用，但其对胃黏膜-黏膜下层来源的各类病变缺乏特异的鉴别手段。由于其中部分病变可能存在恶性潜能，因此在作出诊断时需要更加谨慎。     

子宫恶性中胚叶混合瘤的超声图像及临床病理分析

目的 观察子宫恶性中胚叶混合瘤(MMMT)的超声图像及临床病理特征.方法 回顾分析经手术及病理证实的17例MMMT患者的超声表现、临床症状及病理特征.结果 2例病灶位于宫颈,15例位于宫体;全部为单发;肿块直径2.1 ～9.7(6.5 ±2.7)cm;其中实性结构5例,呈均匀低回声,囊实性结构10例,呈混合/蜂窝状回声,全部表现为边界模糊.CDFI示12例病灶血流丰富,5例病灶血流不丰富.结论 MMMT具有特征性的声像图,其超声表现与病理组织学特征密切相关.     

超声内镜结合内镜黏膜下剥离术对直肠类癌的临床疗效观察

[目的]探讨超声内镜(EUS)结合内镜黏膜下剥离术(ESD)治疗直肠类癌的效果及价值。[方法]对EUS检查发现来源于黏膜下层、无固有肌层受累、无淋巴结转移、直径≤1.5cm、考虑为直肠类癌的21例直肠黏膜隆起病灶行ESD治疗。ESD后6个月、12个月及24个月行EUS随访。[结果]21例均成功完成ESD,瘤体完整剥离,基底及边缘无残留;术中均无穿孔,术后创面少量出血5例,经内科治疗后痊愈;术后病检确诊为类癌,随访6~24个月,无一例病变残留和复发。[结论]EUS结合ESD治疗直径≤1.5cm、未侵犯固有肌层的直肠类癌安全有效,可避免不必要的外科手术。     

直肠类癌内镜黏膜下剥离治疗的临床研究

[目的]探讨超声内镜(endoscopic ultrasonography,EUS)诊断、内镜黏膜下剥离(endoscopic submucosal dissection,ESD)治疗直肠类癌的临床疗效及安全性。[方法]对经EUS证实并行ESD治疗的12例直肠类癌患者的临床资料进行回顾性分析。12例均在内镜下标识预切除范围、黏膜下多次注射、黏膜切开、病变剥离及创面钛夹处理。[结果]12例直肠类癌直径0.6~1.8cm,均一次性切除,病灶基底与周缘无类癌组织累及。随诊6~25个月无复发。[结论]经EUS证实行ESD治疗直径2cm,未浸及固有肌层、无远处转移的直肠类癌疗效确切、安全性好,适宜开展。     

直肠类癌32例临床及病理分析

目的探讨直肠类癌的临床病理特点及治疗。方法对32例经病理诊断的直肠类癌患者的临床资料进行回顾分析,总结其临床表现、治疗情况及随访结果。结果直肠类癌以腹痛(10/32)、大便习惯改变(15/32)、便血(5/32)为主要临床表现,部分为无症状体检时发现直肠黏膜下肿物(5/32)。29例直肠类癌位于肛门8cm以内,内镜下主要表现为半球状隆起,表面黏膜正常。其中17例行超声内镜检查,肿块多位于黏膜下层,为均匀或不均匀稍低回声,边界清晰。内镜下行EMR治疗32例,1例追加外科手术治疗。22例随访5月～5年,1例因伴肝、肺转移死亡,余21例无复发。结论直肠类癌缺乏特异性临床表现,诊断主要靠内镜及组织学检查,内镜下EMR切除是主要治疗方法。     

原发性肝癌超声造影诊断的特征性声像图表现

目的探讨超声造影诊断原发性肝癌的特征性声像图表现。方法对经病理检查或穿刺活组织检查确诊的25例(30个病灶)原发性肝癌患者实施超声造影检查,观察患者病灶特征和声像图表现,并将诊断结果与常规超声诊断结果进行比较,判断两种诊断方式的敏感性。结果原发性肝癌的内部结节数目不多,多为单发,病灶与正常组织间界限清楚,边缘处较为整齐,回声除小部分不均匀外,其余皆比较均匀,其形状表现为圆形或类圆形。有19例患者诊断为肝细胞癌,声像图表现为"快进快出","快进快出"表现越为明显患者,其肿瘤分化程度也越低。有6例患者诊断为肝内胆管细胞癌,声像图主要表现为"快进快出",病灶图像在动脉期呈现为网格状增强,部分显示无增强;在门静脉期时,病灶周边环状不规则增高,病灶内部则表现为网格状增强或无增强;当处于门静脉期时,病灶周边环状不规则增强明显消退。超声造影诊断敏感度为96%,与常规超声的72%比较,存在明显差异(P0.05)。结论超声造影诊断原发性肝癌可以清楚的显示病灶图像特征,较常规超声诊断敏感性高。     

直肠子宫内膜异位症10例临床分析

目的分析直肠子宫内膜异位症的临床特点及诊治方法。 方法回顾性分析2020年1月至2022年1月江苏省苏北人民医院经手术病理确诊的10例直肠子宫内膜异位患者的临床资料及超声内镜检查结果。 结果10例患者肠镜下表现为直肠前壁或侧壁黏膜下隆起性病变。病灶距肛门口5~15 cm，大小为1.5~2.8 cm。其中4例误诊为直肠良性肿瘤或者直肠癌，误诊率达40.0%（4/10）。10例患者均经超声内镜检查诊断为直肠子宫内膜异位症，超声内镜检查见病灶位于直肠黏膜下及固有肌层，呈低回声影，内部回声不匀，部分突破外膜累及子宫。 结论直肠子宫内膜异位症虽然误诊率较高，但超声内镜检查有助于辅助诊断，提高诊断准确率。     

Examination of endoscopical ultrasonography (EUS) on carcinoid tumors of gastrointestinal tract

In order to clarify the usefulness of EUS in the diagnosis of gastrointestinal carcinoid tumor, we examined 15 patients, who had carcinoid tumors of gastrointestinal tract (stomach: 5, duodenum: 2, rectum: 8), on the diagnosis in quality and depth by comparing endoscopical ultrasonography (EUS) with resected specimen. Carcinoid tumors of gastrointestinal tract were detected as homogenous hypoechoic tumors with sharp border in all site by EUS. Especially, it was characteristic that 14 of the 17 lesions (82%) which invaded into submucosa were mainly located in the third layer, and the second layer covered the tumor at the foot, and near the top, it touched the tumor and got indistinct. We decided the depth of invasion by comparing the hypoechoic tumor with normal structure of 5 layers. The accuracy rate was 88%. In conclusion, EUS was thought to be useful in the diagnosis and choice for treatment of carcinoid tumors of gastrointestinal tract.     

胃肠道类癌的内镜下诊断与治疗

目的探讨内镜在胃肠道类癌诊断治疗中的作用。方法对44例病理确诊的胃肠类癌患者的内镜下诊断及治疗等资料进行回顾分析,总结其内镜下表现特点、治疗情况及随访结果。结果类癌患者常因腹痛和排便习惯改变就诊发现,部分为无症状查体发现。胃肠类癌多为黏膜下隆起病灶,PitⅠ型;大的肿物可表现为息肉样,Pit Ⅲ型;少数为恶性类癌,Pit Ⅴ型。29例行超声内镜检查,超声内镜下表现为低回声或低回声为主病变,边界清。内镜下高频电凝切除术治疗12例,内镜下黏膜切除术治疗32例。除1例恶性类癌诊断半年后全身转移死亡外,余43例内镜下切除治疗后随访3个月至5年无1例复发。结论胃肠类癌缺乏特异临床表现,内镜下可对胃肠道类癌进行诊断和治疗。     

线阵超声内镜对直肠子宫内膜异位症的诊断价值

目的:探讨线阵超声内镜对直肠子宫内膜异位症(rectal endometriosis,RE)的诊断价值.方法:对20例子宫内膜异位症患者于外科手术前行线阵超声内镜检查直肠,超声扫描频率为7.5MHz,根据直肠壁内有无边界不规则的低回声结节或团块判断直肠是否受累,并将超声内镜检查结果与手术中所见及术后病理进行比较.结果:20例患者中有12例经线阵超声内镜检查发现直肠壁内有异位子宫内膜病灶,其余8例患者的直肠壁正常.超声内镜诊断为RE的12例患者术中均见盆腔异位子宫内膜病灶与肠壁粘连紧密,手术切除的直肠病灶送检均见子宫内膜组织.超声内镜下未见直肠受累的8例患者盆腔子宫内膜异位病灶与肠壁无粘连或轻度粘连,易分离,分离缘组织送检未见子宫内膜组织.线阵超声内镜检查结果与手术中所见及术后病理完全一致.结论:线阵超声内镜检查是诊断RE的可靠方法,可对子宫内膜异位症患者是否伴有直肠受累做出准确的术前评估.     

Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms

AIM:To investigate the diagnostic accuracy of endoscopic ultrasonography(EUS)for rectal neuroendocrine neoplasms(NENs)and the differential diagnosis of rectal NENs from other subepithelial lesions(SELs).METHODS:The study group consisted of 36 consecutive patients with rectal NENs histopathologically diagnosed using biopsy and/or resected specimens.The control group consisted of 31 patients with homochronous rectal non-NEN SELs confirmed by pathology.Epithelial lesions such as cancer and adenoma were excluded from this study.One EUS expert blinded to the histological results reviewed the ultrasonic images.The size,original layer,echoic intensity and homogeneity of the lesions and the perifocal structures were investigated.The single EUS diagnosis recorded by the EUS expert was compared with the histological results.RESULTS:All NENs were located at the rectum 2-10 cm from the anus and appeared as nodular(n=12),round(n=19)or egg-shaped(n=5)lesions with a hypoechoic(n=7)or intermediate(n=29)echo pattern and a distinct border.Tumors ranged in size from 2.3 to 13.7 mm,with an average size of 6.8 mm.Homogeneous echogenicity was seen in all tumors except three.Apart from three patients(stage T2 in two and stage T3 in one),the tumors were located in the second and/or third wall layer without involvement of the fourth and fifth layers.In the patients with stage T1 disease,the tumors were located in the second wall layer only in seven cases,the third wall layer only in two cases,and both the second and third wall layers in27 cases.Approximately 94.4%(34/36)of rectal NENs were diagnosed correctly by EUS,and 74.2%(23/31)of other rectal SELs were classified correctly as nonNENs.Eight cases of other SELs were misdiagnosed as NENs,including two cases of inflammatory lesions and one case each of gastrointestinal tumor,endometriosis,metastatic tumor,lymphoma,neurilemmoma,and hemangioma.The positive predictive value of EUS for rectal NENs was 80.9%(34/42),the negative predictive value was 92.0%(23/25),and the diagnostic accuracy was85.1%.CONCLUSION:EUS has satisfactory diagnostic accuracy for rectal NENs with good sensitivity,but unfavorable specificity,making the differential diagnosis of NENs from other SELs challenging.     

EUS features of recurrent transitional cell bladder cancer metastatic to the GI tract

BACKGROUND: Recurrent transitional cell bladder cancer (TCBC) can metastasize to the GI tract albeit uncommonly. This is the first report of the EUS appearance of metastatic TCBC to the GI tract. In addition to describing the EUS features of recurrent metastatic TCBC, this study determined the number of patients referred for evaluation of a primary GI luminal cancer in which EUS instead established the diagnosis of metastatic recurrent TCBC. METHODS: Patients referred from July 2000 through April 2004 for EUS evaluation of a suspected primary GI luminal cancer were retrospectively reviewed. For patients with an established diagnosis of recurrent metastatic TCBC, EUS images were retrospectively reviewed to identify characteristic features. RESULTS: Of 2216 patients undergoing EUS to evaluate a suspected primary GI luminal cancer, 3 men (0.14%: 95% confidence interval [0.02%, 0.29%]) (mean age 67 years, range 54-74 years) were found instead to have recurrent metastatic TCBC involving the duodenum (n = 1) or rectum (n = 2). The patients presented a mean of 32 months after diagnosis of the primary TCBC with change in bowel habit (n = 1) and symptoms of bowel obstruction (n = 2). In each patient, initial endoscopy revealed circumferential luminal stenosis and mucosal erythema, but mucosal biopsy specimens revealed normal tissue. EUS demonstrated hypoechoic, symmetric, circumferential wall thickening, loss of deep wall layers, and pseudopodia-like extensions into the peri-intestinal tissues. In the two patients with rectal involvement, no evidence of direct infiltration from the bladder bed was seen. EUS-guided FNA was diagnostic of metastatic TCBC in all patients. CONCLUSIONS: Although most cases of hypoechoic bowel-wall thickening and stenosis are from primary GI neoplasia, recurrent TCBC should be considered in patients with a history of this tumor. Correct diagnosis is important, because this allows selection of appropriate therapeutic interventions. Although firm EUS criteria for TCBC cannot be established based on findings in 3 patients, certain features may prove useful. EUS-guided FNA can confirm the diagnosis.     

超声内镜引导深挖活检联合黏膜切除术诊治早期直肠类癌

目的 探讨超声内镜引导下深挖活检早期诊断直肠类癌以及内镜下黏膜切除术治疗直肠类癌的安全性、有效性。方法在超声内镜引导下深挖活检、结合病理及免疫组化检查,诊断直肠类癌24例。对24例直肠类癌的内镜及超声影像特点进行回顾性分析,总结其特征。对病灶直径小于1．5cm、浸润深度不超过黏膜下层、无肝转移及腹水发生的直肠类癌采取内镜下黏膜切除术治疗。结果24例直肠类癌分别距离肛缘5cm～12cm,病灶大小0．8cm～1．5cm,术后切除的标本切缘完整,基底无残留,治疗过程中均未发生穿孔,无迟发性出血,术后创面即刻渗血1例,经内镜治疗血止。随访3至5年无转移及再发。结论直肠类癌可通过超声内镜引导下深挖活检,钳取组织行病理及免疫组化检查而确诊,内镜下黏膜切除术治疗直径小于1．5cm的直肠类癌简单、安全有效。     

EUS IN THE DIAGNOSIS OF ULCERATIVE COLITIS

The ultrasonograms of ulcerative colitis (UC) in active stage show hypoechoic changes of the colorectal wall from the mucosal layer to the deeper layers. These endoscopic ultrasound (EUS) changes of the wall recognized in active stage disappear or normalize in the stage of remission. When the stage of UC is exacerbated, the hypoechoic changes of the wall extend from the mucosal layer to the deeper layers with the increase of wall thickness. These EUS images of active UC are classified into the following types: UC‐M, thickening of the whole wall with the structure preserved; UC‐SM, hypoechoic changes reach the superficial portion of third layer with the thickening of whole wall; UC‐SM deep, hypoechoic changes reach the deeper portion of third layer with the thickening of whole wall; UC‐MP, hypoechoic changes reach the fourth layer with the thickening of whole wall; UC‐SS/SE, hypoechoic changes penetrate through the fourth layer with the thickening of whole wall. With the help of EUS we can demonstrate the severity of inflammation in UC. Moreover, in severe cases of UC, the treatment strategy including emergency surgery can be determined. EUS is a valuable method in the management of UC.     

Factors associated with complete local excision of small rectal carcinoid tumor

Purpose

Although small rectal carcinoid tumors can be treated using local excision, complete resection can be difficult because tumors are located in the submucosal layer. We evaluate the factors associated with pathologically complete local resection of rectal carcinoid tumors.

Methods

Data were analyzed of 161 patients with 166 rectal carcinoid tumors who underwent local excision with curative intent from January 2001 to December 2010. A pathologically complete resection (P-CR) was defined as an en bloc resection with tumor-free lateral and deep margins. The study classified treatments into three categories for analysis: conventional polypectomy (including strip biopsy, snare polypectomy, and hot biopsy), advanced endoscopic techniques (including endoscopic mucosal resection with cap and endoscopic submucosal dissection), and surgical local excision (including transanal excision and transanal endoscopic microsurgery). We evaluated the P-CR rate according to treatment method, tumor size, initial endoscopic impression and the use of endoscopic ultrasound (EUS) or transrectal ultrasound (TRUS).

Results

The mean tumor size was 5.51?±?2.43 mm (range 2–18 mm) and all lesions were confined to the submucosal layer. The P-CR rates were 30.9, 72.0, and 81.8 % for conventional polypectomy, advanced endoscopic techniques, and surgical local excision, respectively. Univariate analysis showed that P-CR was associated with treatment method, use of EUS or TRUS, and initial endoscopic impression. Multivariate analysis showed that only treatment method was associated with P-CR.

Conclusion

Pathologically complete resection of small rectal carcinoid tumors was more likely to be achieved when using advanced endoscopic techniques or surgical local excision rather than conventional polypectomy.