原发性胃恶性淋巴瘤的内镜诊断

目的　探讨原发性胃恶性淋巴瘤 (PGML)临床病理特征、胃镜及超声内镜下特点 ,提高对其诊断水平。方法　回顾性分析了经病理证实的 2 2例PGML的临床和内镜资料。结果　 2 2例患者主要症状为腹痛、纳减、体重减轻等。胃镜下表现为肿块性、溃疡性及弥漫浸润性损害 ,胃镜活检病理诊断PGML 13例。 6例行超声内镜检查均显示为起源于胃黏膜下层的低回声病灶 ,其中 2例见胃壁外的肿大淋巴结 ,均诊断为PGML。结论　原发性胃恶性淋巴瘤发病率低 ,临床表现无特异性 ,胃镜下表现与胃溃疡或胃癌等病变难以区分 ,进一步超声内镜检查 ,结合胃镜及病理检查有助于最终确诊。     

原发性胃淋巴瘤超声内镜诊断探讨

目的评估超声内镜（endoscopic uhrasonography，EUS）在诊断原发性胃淋巴瘤（primary gastric lymphoma，PGI）中的价值。方法对18例PGI患者行EUS检查，并对声像图进行分析，将结果与普通内镜与外科手术相比较。结果PGI的EUS声像图表现为表浅扩散型（16．67％）、弥漫浸润型（38．89％）、肿块型（27．78％）、混合型（16．67％）；EUS诊断PGI符合率为88．89％，与普通胃镜相比（55．56％），差异显著；EUS对PGI的T、N分期诊断准确性分别达到100％、72、73％。结论EUS诊断PGI符合率高于普通胃镜，并能准确判断肿瘤浸润胃壁深度、侵犯周围器官及淋巴结情况，EUS结合病理检查为诊断PGI的一项有效手段。     

内镜超声对皮革胃的诊断价值

目的　探讨内镜超声检查 (EUS)对皮革胃的诊断价值。方法　对 2 1例皮革胃患者行EUS检查 ,并将其结果与内镜、胃肠道钡餐、CT检查及术后病理结果进行对照研究。结果　皮革胃的EUS声像图表现为 (1 )病灶处胃壁第 2、3、4层明显增厚 ,所侵犯胃壁层次结构消失 ,胃壁增厚处平均 (1 6 8± 0 37)cm ;(2 )大多数 (95 2 4 % )呈低回声改变 ;(3)EUS下病灶范围超过内镜所见异常区域 ;(4 ) 85 7%的患者病变沿胃的横轴生长呈连续性分布 ;(5 )病灶边界较容易分辨 ,但图像放大观察交界处模糊 ,是皮革胃浸润生长的标志。EUS对皮革胃的诊断符合率为 90 4 8% ,显著高于常规内镜检查的 5 2 38% (P =0 0 0 95 )、胃肠道钡餐的 6 1 1 1 % (P =0 0 396 )及CT检查的 35 2 9% (P =0 0 0 5 9)。术前EUS对皮革胃的T、N分期诊断的准确性分别为 80 95 %、85 71 % ,EUS对皮革胃可切除性判断的准确率为 71 4 3%。结论　EUS能提高内镜诊断皮革胃的准确率并对其病变的范围和可切除性的判断有重要的价值     

内镜检查对原发性胃恶性淋巴瘤诊断意义

目的:分析原发性胃恶性淋巴瘤内镜下表现特征及其病理学特点.方法:我院2004-01/2008-03住院PGML患者34例,所有患者经病理组织学证实,患者均行电子胃镜检查,并行黏膜活检病理检查,同时行免疫组织化学染色检测CD3、CD20、CD45和CK等标志物,并行病理组织HE染色,阳性即判为有H pylori 感染.结果:内镜检查34例患者,病变主要在胃体(44.1%)和胃窦(29.4%),其中累及2个及其以上病变部位占61.8%,单一部位相对较少;形态表现多为溃疡型(61.8%),主要是多发性溃疡(66.7%),弥散浸润型(26.5%),隆起糜烂型(11.8%).病理结果均为B细胞非霍奇金淋巴瘤,4例(11.8%)为大B细胞性淋巴瘤,为高度恶性胃淋巴瘤,30例(88.2%)为低度恶性淋巴瘤;幽门螺杆菌(Hpylon)感染率为占82.4%.结论:内镜检查的广泛应用及活检的充分和准确,对于PGML具有重要的确诊意义.     

胃原发性恶性淋巴瘤的内镜诊断探讨

本文分析了我院１９９１的３月至１９９５年８月经手术病理证实的１６例胃恶性淋巴瘤的内镜下特点。点镜所见以溃疡型多见，共８例。病灶多为不规则巨大溃疡，呈放射状或地图状，形态各异。息肉样型５例，表现为息肉或结节样隆起。浸润型３例，呈广泛性浅表溃疡。     

超声内镜与螺旋CT检查对胃淋巴瘤诊断价值的比较

目的 为胃淋巴瘤临床诊断方法提供内镜与影像学的选择依据,提高该病的临床诊断水平.方法 回顾分析22例原发性胃淋巴瘤患者超声内镜(EUS)与多层螺旋电子计算机断层扫描(MSCT)的检查结果,比较胃淋巴瘤患者在两种检查方法中的特征性表现,以评价两种方法对该病的诊断价值.结果 MSCT与EUS比较,两者对于胃淋巴瘤的多部位累及、累及范围、胃壁厚度、胃腔僵硬度、淋巴结累及、浆膜层累及和胃外其他器官的侵犯等比较差异均无统计学意义(P＞0.05),而对病灶处胃壁层次结构的辨认比较,EUS比MSCT优势明显,两者比较差异有统计学意义(P＜0.05).结论 EUS与MSCT检查对胃淋巴瘤均有相当的诊断价值,对于胃壁病灶层次结构的显示,EUS较MSCT有较明显的优势,两者结合能提高胃淋巴瘤的诊断率.     

胃镜在胃原发性恶性淋巴瘤诊断中的价值

为近一步探讨胃原发性恶性淋巴瘤的发病机制，提高对胃原发性恶性淋巴瘤胃镜及病理表现的认识，对１０年间经胃镜活检诊断为胃恶性淋巴瘤的１９例，可疑胃恶性淋巴瘤，低分化癌，未分化癌，溃疡及淋巴组织明显一增生的１２１例病理标本，临床资料进行回顾复习，最后确认有３８例符合胃恶性淋巴瘤的诊断标准。胃镜下多形性，多灶性，弥漫性，范围广是其特征表现，而组织学上粘膜相关性淋巴组织的特点对确诊本病有重要意义。     

内镜超声检查术对十二指肠囊肿的诊断价值

目的 研究内镜超声检查术（EUS）对十二指肠囊肿的诊断价值.方法 分析十二指肠囊肿患者的临床表现,普通胃镜、EUS的结果和随访结果,研究总结该病的超声影像学特征.结果 105例十二指肠囊肿患者均无与病灶相关的症状,该病在超声内镜下具有特征性的影像学改变,即黏膜下病灶位于肠壁内,探头触压病灶易变形,内呈无回声状,边界清楚,源于黏膜下层,后方有回声增强效应,周围肠壁层次结构正常.EUS可明确病灶的起源、大小和性质并与其他黏膜下病变相鉴别.术后随访5年病灶无明显变化.结论 十二指肠囊肿属良性疾病,EUS对该病的诊断具有较好的临床价值.     

内镜检查疑诊、漏诊皮革胃的超声诊断

目的通过与手术、病理对照分析研究，探讨B超检查对内镜检查疑诊、漏诊皮革胃的诊断价值．方法内镜检查疑诊、漏诊皮革胃患者13例，2wk内行B超检查．采用ATLUM－4型B超仪．探头频率3．0MHz．检查前空腹8h以上，先取平卧位，B超检查空腹时胃部情况；然后取坐位，服胃B超快速显影剂500mL，探头于上腹部作连续多切面扫查，详细观察胃腔、胃壁、胃周和腹腔的声象图改变，并随时摄片记录．结果13例B超诊断皮革胃者中，12例行手术治疗，术中发现11例全胃壁或胃壁大部分浸润僵硬呈皮革状；术后标本病理提示低分化腺癌5例，印戒细胞癌和未分化癌各2例，粘液腺癌1例；胃恶性淋巴瘤和慢性肥厚性胃炎各1例．1例B超诊断皮革胃并肝转移，在B超引导下行肝穿刺活检证实为转移性腺癌而未行手术．本组B超诊断皮革胃符合率84．61％（11／13）．结论B超对内镜检查疑诊、漏诊的皮革胃患者具有重要的诊断价值．     

超声内镜在活检阴性皮革胃的诊断价值

超声内镜在活检阴性皮革胃的诊断价值陈贻胜林海潘秀珍皮革胃（ｇａｓｔｒｉｃｌｉｎｉｔｉｓｐｌａｓｔｉｃａ）系一特殊类型进展期胃癌，即弥漫浸润型、ＢｏｒｒｍａｎｎＩＶ型胃癌。由于其具有独特的生物学行为，恶性程度极高，生存期短，预后不佳，且早期缺乏粘膜改变...     

内镜超声检查在胃癌诊断和分期中的临床应用

目的评价内镜超声检查(EUS)对胃癌患者术前诊断和分期的准确性,以指导临床治疗方案的选择。方法22例经胃镜加活检病理检查确诊(17例)和疑诊为胃癌但常规活检阴性的患者(5例),同时行EUS、腹部螺旋CT检查,疑诊者在EUS检查的同时行EUS引导下细针穿刺活检(FNAB)以明确诊断。确定肿瘤侵犯深度(T)、局部淋巴结转移(N)、周围及远处器官转移(M)等分期情况,并与手术及病理对照,以评价EUS对胃癌诊断及TNM临床分期的准确性。结果5例疑诊者行EUS引导下FNAB全部成功取得肿瘤组织,病理诊断腺癌4例,印戒细胞癌1例。1例术前EUS诊断为T1N0M0期的患者行内镜下黏膜切除术,其余患者全部行外科胃癌根治术。与手术和病理结果比较,EUS对于TNM分期诊断总的敏感性和特异性分别为T:84.9%,74.2%;N:92.1%,77.1%;M:63.4%,87.5%。螺旋CT对于胃壁是否增厚及N、M分期的敏感性和特异性分别为T:27.3%,75%;N:31.5%,100%;M:50%,100%。其中EUS对于T和N分期的敏感性较CT高(P<0.05)。结论EUS术前评价胃癌临床分期具有显著的优越性,尤其是对于肿瘤侵犯深度和局部淋巴结转移的诊断,对指导临床治疗方案的选择及术后随访具有重要的参考价值。     

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目的提高对胃异位胰腺的诊断及治疗水平。方法2000-2004年对解放军总医院消化科241例胃黏膜下肿物进行超声内镜(EUS)检查,回顾分析胃异位胰腺的图像特征。结果EUS诊断良性间质瘤105例,恶性间质瘤23例,脂肪瘤48例,异位胰腺45例,囊肿20例。异位胰腺EUS图像特点:(1)黏膜下层病变39例,6例与固有肌层无分界;(2)边界清37例;(3)42例为不均匀、形状不规则中强回声,3例为不均匀低回声;(4)32例中心有小的不规则液性回声。内镜电切26例,无出血穿孔等并发症。结论超声内镜对胃异位胰腺的诊断有一定价值,内镜切除是安全有效的治疗方法。     

Endoscopic ultrasound-guided deep and large biopsy for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies

AIM: To assess the diagnostic yield and safety of adeep and large biopsy technique under the guidance of endoscopic ultrasound(EUS) for diagnosis of gastric infiltrating tumors with negative malignant endoscopy biopsies.METHODS: From January 2009 to March 2014, 36 patients in whom gastric infiltrating tumors had been diagnosed by EUS received negative results for malignancy after endoscopic biopsies. The deep and large biopsy technique combined bite-on-bite technique with or without endoscopic mucosal resection(EMR) to obtain submucosal tissue from lesions. EUS was used to select the appropriate biopsy sites. If the lesion protruded into the cavity, EMR was performed for removal of the overlying mucosa and then bite-onbite technique was conducted in the resected area to obtain submucosal tissue. If the lesion appeared to be flat or was difficult to lift by injection, the bite-on-bite technique was directly used.RESULTS: Twenty-eight of the 36 patients were treated by EMR followed by bite-on-bite technique, while 8 patients only underwent bite-on-bite technique. Histological results showed 23 of the 36 lesions were poorly differentiated adenocarcinomas, 2 diffuse large B cell lymphomas, 4 mucosa-associated lymphoid tissue-type lymphomas, and 7 undiagnosed. The deep and large biopsy technique provided a definitive and conclusive diagnosis in 29(80.6%) of the 36 patients. The 12 gastric linitis plastica and 6 lymphoma patients received chemotherapy and avoided surgery. Minor oozing of blood in 2 mucosal resection wounds was managed by argon plasma coagulation and in 5 cases after deep biopsies by epinephrine(0.001%). Neither severe hemorrhage nor perforation occurred in any patient.CONCLUSION: The deep and large biopsy technique is superior to ordinary endoscopic biopsy for achieving an accurate diagnosis of gastric infiltrating tumors.This procedure guided by EUS is an effective and safe diagnostic method for gastric infiltrating tumors in which endoscopic biopsy results were negative for malignancy.     

Usefulness of endoscopic ultrasonography in preoperative TNM staging of gastric cancer

AIM:To evaluate the value of endoscopic ultrasono-graphy (EUS) in the preoperative TNM staging of gastriccancer.METHODS :Forty-one patients with gastric cancer(12 early stage and 29 advanced stage) provedby esophagogastroduodenoscopy and biopsiespreoperatively evaluated with EUS according to TNM(1997) classification of International Union ContreleCancer (UICC).Pentax EG-3630U/Hitachi EUB-525 echoendoscope with real-time ultrasound imaging linearscanning transducers (7.5 and 5.0 MHz) and Dopplerinformation was used in the current study.EUS stagingprocedures for tumor depth of invasion (T stage) wereperformed according to the widely accepted five-layerstructure of the gastric wall.All patients underwentsurgery.Diagnostic accuracy of EUS for TNM stagingof gastric cancer was determined by comparingpreoperative EUS with subsequent postoperativehistopathologic findings.RESULTS:The overall diagnostic accuracy of EUS inpreoperative determination of cancer depth of invasionwas 68.3% (41128) and 83.3% (12110),60% (20112),100% (5/5),25% (4/1) for T1,T2,T3,and T4,respectively.The rates for overstaging and understagingwere 24.4% (41/10),and 7.3% (41/3),respectively.EUStended to overstage T criteria,and main reasons foroverstaging were thickening of the gastric wall due toperifocal inflammatory change,and absence of serosallayer in certain areas of the stomach.The diagnosticaccuracy of metastatic lymph node involvement or Nstaging of EUS was 100% (17/17) for NO and 41.7%(24/10) for N ,respectively,and 66% (41/27) overall. Misdiagnosing of the metastatic lymph nodes was relatedto the difficulty of distinguishing inflammatory lymphnodes from malignant lymph nodes,which imitate similarecho features.Predominant location and distribution oftumors in the stomach were in the antrum (20 patients),and the lesser curvature (17 patients),respectively.Three cases were found as surgically unresectable (T4 N ),and included as being correctly diagnosed by EUS.     

十二指肠隆起性病变超声内镜频率选择的临床研究

目的探讨超声内镜扫查不同大小十二指肠隆起性病变时频率的选择。方法对常规胃镜发现的201例患者210个十二指肠隆起性病灶,根据病灶特征和超声图像清晰度,选择不同扫查频率进行超声胃镜或者微型探头扫查。在征得患者同意后,对病灶进行相应的病理检查,并将病理检查结果与EUS诊断结果进行对比分析。结果EUS与病理诊断结果的符合率为81．4％（22／27）。低频扫描易于显示病灶全貌,对扫查直径≥1．5cm的病灶及高回声病灶具有优势,而高频扫描易于显示微细层次结构,扫查直径〈1．5cm病灶更为有利,联合使用多种频率扫描较大病灶能够提供更多影像信息。结论对于不同大小的隆起性病灶,选择合适的超声扫查频率或联合使用多种扫查频率有助于EUS对十二指肠隆起性病变的诊断。     

超声内镜对胃癌术前分期的诊断价值

目的评估超声内镜在胃癌术前分期的价值。方法 75例经胃镜及病理证实的胃癌患者于术前进行超声内镜检查,并与术后组织病理分期比较。结果超声内镜分期结果与病理学分期结果比较,超声内镜对胃癌术前T分期判断的准确率为82.7%、N分期判断的准确率为86.7%。结论超声内镜能较准确地判断胃癌分期,有助于制订合理的手术方案。