超声内镜引导下Trucut穿刺活检诊断上消化道黏膜下肿瘤的初步经验

目的评估超声内镜引导下Trucut穿刺活检技术(EUS-TCB)对消化道黏膜下肿瘤穿刺活检的有效性及安全性。方法回顾性分析EUS-TCB对12例患者上消化道黏膜下肿瘤的穿刺活检,其中食管黏膜下肿瘤4例,胃黏膜下肿瘤6例,十二指肠黏膜下肿瘤2例。行超声内镜检查及其引导下的Trucut穿刺活检,穿刺获取的组织标本通过免疫组化染色等进行病理组织学检查,并观察穿刺部位的出血状况。结果对12例黏膜下病灶共穿刺36次,30次(83．3%)成功获取组织条块,6次(16．7%)穿刺未取得有效组织；7次(23．3%)穿刺获得的组织为片段状碎块,23次(76．7%)为完整的条状组织。病理检查证实食管鳞癌1例,食管平滑肌瘤3例,胃间质瘤4例,胃平滑肌瘤1例,胃癌(印戒细胞癌)1例,十二指肠降段间质瘤1例。无严重并发症发生。结论超声内镜引导下Trucut穿刺活检诊断上消化道黏膜下肿瘤安全、有效,可获得满意的病理组织,对十二指肠黏膜下肿瘤的诊断效果尚待进一步研究。

Primary experiences in Trucut needle biopsy under the guidance of EUS for diagnosing submucosal tumors of upper GI tract

Objective To study on the efficiency and safety of Trucut biopsy guided by endoscopic uhrasonography(EUS-TCB)in diagnosing submucosal tumor.Methods Twelve patients with submucosal tumors were provided with EUS-TCB and retrospectively analysed.Among these patients,totally 12 submu- cosal tumors located in esophageal(4),gastric(6)and duodenal(2)mueosa were punctured with EUS-TCB and tissues obtained were sent for pathologic analysis.The bleeding status at the puncture site was observed after the procedure.Results Thirty six times of puncture were taken in 12 patients.30(83.3%)of them had successfully obtained tumor tissues while 6(16.7%)times were failed to get enough tissue.Tissues cores were obtained in 23(76.7%)of biopsies and debris in 7(23.3%).Pathologic exam confirmed esoph- ageal squamaous carcinoma in 1 patient,esophageal leiomyoma in 3 patients,gastric GIST in 4 patients, gastric leiomyoma in 4 patients,and duodenal GIST in 1 patient.No serious complication happened.Conclu- sion EUS-TCB is an effective and safe method to obtain tissue cores for pathologic study from submucosal tumors in upper GI tract.Its efficacy in diagnosing submucosal tumors located at the second part of duodenal should be further studied.