内镜超声诊断上消化道黏膜下低回声病变的价值及病理性质探讨

目的:探讨上消化道黏膜下低回声病变的病理性质及内镜超声的诊断价值。方法:超声内镜诊断为上消化道黏膜下低回声病变94例,通过内镜下微创治疗、外科手术治疗、超声内镜引导下细针穿刺活检术等手段获取病理组织并经常规病理、细胞学与免疫组织化学检查(SMA、CD117、CD34、S-100等),并分析内镜超声图像(包括大小、层次、回声、有否液性暗区及分叶、边缘的声晕等)。结果:94例消化道黏膜下低回声病变,36例食管病变:平滑肌瘤26例,平滑肌肉瘤2例,间质瘤8例(其中2例为恶性);58例胃部病变:间质瘤52例,平滑肌瘤6例。结论:消化道黏膜下低回声病变,在食管以平滑肌瘤多见;在胃以间质瘤多见。内镜超声能准确诊断胃肠道间叶源性肿瘤,对良恶性鉴别有一定的价值,但很难区别间质瘤和平滑肌瘤,结合EUS引导下细针穿刺活检术是未来的诊断选择。

Endoscopic ultrasonography in diagnosis of hypoechoic upper gastrointestinal submucosal masses with pathologic nature study

Objective：To investigate the pathologic nature of hypoechoic upper gastrointestina1 submucosal masses and evaluate the diagnostic value of endoscopic ultrasonography in these lesions.Methods：Ninety-four cases were diagnosed as hypoechoic upper gastrointestina1 submucosal lesions by endoscopic ultrasonography,and the lesion samples were obtained by endoscopic therapy,surgical intervention and endoscopic ultrasound-guided fine-needle aspiration（EUS-FNA）and detected by general pathological,cytological examination and immunohistochemistry concerning smooth muscle myosins（SMA,CD117,CD34 and S-100）,also,the endoscopic images were analyzed examined regarding the sizes of the masses,layers,echogenicity,presence or absence of cystic-liquid dark area and acoustic halo.Results：Of the 94 hypoechoic upper gastrointestinal submucosal lesions diagnosed by endoscopic ultrasonography,36 were esophageal lesions,26,leiomyoma,2,leiomyosarcoma and 8,gastrointestinal stromal tumors,in which 2 were malignant.In the 58 gastric lesions,52 were gastrointestinal stromal tumors and 6,leiomyoma.Conclusion：Hypoechoic upper gastrointestinal submucosal lesion commonly presents itself in esophagus with leiomyoma and in stomach with gastrointestinal stromal tumor.Endoscopic ultrasonography appears valuable and competent in diagnosis of gastrointestinal mesenchymal tumor,but is difficultly to differentiate gastrointestinal stromal tumor and leiomyoma.Endoscopic ultrasonography guided fine-needle aspiration biopsy may be the better diagnostic policy in the future.