原发性结直肠恶性淋巴瘤21例分析

目的探讨原发性结直肠恶性淋巴瘤的诊断和治疗方法。方法对21例原发性结直肠恶性淋巴瘤的临床资料进行回顾性分析。结果 21例结直肠淋巴瘤,其中盲肠10例,升结肠2例,横结肠3例,降结肠及乙状结肠3例,直肠2例,直肠及乙状结肠病变部位大于2个1例。术前内镜活检病理诊断结直肠淋巴瘤9例,消化道造影、B超、CT检查确诊率低。单化疗1例;手术4例;手术结合化疗15例,内科保守治疗1例。结论原发性结直肠恶性淋巴瘤临床表现无特异性,内镜病理活检是确立诊断的重要方法。早期诊断,积极治疗是改善预后的关键。     

应用结扎技术进行内镜黏膜下切除术治疗直肠小类癌

目的 探讨应用结扎技术进行内镜黏膜下切除术(ESMR-L)对直肠小类癌的治疗价值.方法 选择超声内镜检查(EUS)来源于直肠黏膜肌层及黏膜下层的黏膜下肿瘤(SMT)12例(肿瘤直径≤15 mm),应用结扎技术进行内镜黏膜下切除治疗,术后常规内镜及EUS随访.结果 12例病变一次性完整切除,术后病理诊断为直肠类癌11例,平滑肌瘤1例.结论 应用结扎技术进行内镜黏膜下切除术(ESMR-L)是治疗直肠小类癌安全、有效的方法 .可完整切除病变,提供完整的病理学诊断资料,达到与外科手术同样的治疗效果.     

上消化道结核3例报道及超声内镜诊断分析

目的 研究上消化道结核的发生及超声内镜(EUS)的诊断价值.方法 收集患者病史资料,采用超声内镜引导下细针穿刺抽吸术(EUS-FNA)、手术、深挖活检的方法采集标本,进行病理学诊断,并给予抗结核治疗.结果 3例患者均有邻近部位结核或结核病史,临床分别主要表现为食道梗阻和腹部疼痛.胃镜检查显示食管或胃窦病变部位呈局部隆起,黏膜破渍或光滑;EUS见病变累及食管或胃壁全层,为不均匀的低回声;病理学可见结核结节及中央少量干酪样坏死病变,有结核肉芽肿;抗结核治疗有效.结论 结核分枝杆菌可累及上消化道,以继发性多见;深挖活检和EUS-FNA可提高上消化道结核的诊断.     

胃黏膜活检高级别上皮内瘤术前超声内镜检查应用价值的研究

目的探讨超声内镜(EUS)对活检胃黏膜高级别上皮内瘤(HGIEN)病变浸润深度的术前判定的准确性研究。方法选取近3年104例胃黏膜活检组织示HGIEN患者,术前行EUS检查初步判断病变浸润深度,根据EUS术前分期的结果指导行黏膜下剥离术(ESD)或外科手术治疗。观察术后病理结果,比较EUS对病变浸润深度判断的准确率。结果 104例患者术前EUS示:34例局限在黏膜层病变考虑为早期胃癌,其中有32例行ESD,2例选择行外科手术,有30例术前EUS诊断结果与术后病理检查病变浸润深度符合,在该组EUS检查阳性预测值88.2%(30/34);70例为低回声病变浸润至肌层以外考虑为进展期胃癌,对其行外科手术治疗,有65例EUS诊断与术后病理检查病变浸润深度符合,EUS对非早期胃癌检查阴性预测值92.9%(65/70)。结论活检组织胃黏膜HGIEN术前行EUS检查,EUS诊断结果对病变浸润深度具有较高的准确性,对手术方式的选择有一定的指导意义。     

超声内镜在食管结核诊断中的9例应用并文献复习

目的总结食管结核超声内镜(EUS)声像图特征及其他临床资料结果,提高该病的诊断率。方法回顾性分析该院2011年6月-2016年5月经EUS检查或内镜超声引导下细针穿刺活检(EUS-FNA)而确诊为食管结核的9例患者的临床资料,并复习国内外文献。结果 9例患者中,表现为吞咽梗阻6例,胸骨后疼痛3例,伴有盗汗、低热症状2例,伴咳嗽、咯血1例,伴咽痛1例;病变位于食管中段7例(77.78%),上段1例,食管下段合并咽部病变1例;8例为隆起型病变,其中4例表面破溃,1例呈息肉样隆起,另1例为溃疡并憩室型病变;内镜下活检6例中5例确诊,其中3例活检2次;EUS表现为食管壁内不均质低回声占位,边界模糊,内见高回声光斑,侵及黏膜下层或全层,部分病灶突破外膜层与壁外肿大淋巴结融合贯通;2例行EUS-FNA穿刺,病理发现炎性肉芽肿,考虑结核;均予以抗结核治疗后症状缓解。结论食管结核临床表现主要为吞咽困难,好发于食管中段,内镜下表现主要为隆起型和溃疡型病变,通过多次内镜下活检,结合EUS特征或EUS-FNA穿刺病理学检查能明显提高该病的诊断率,减少误诊率。     

消化道类癌38例的临床分析

目的总结消化道类癌的临床特点和诊治方法。方法回顾性分析我院2008年1月至2012年1月诊断的38例消化道类癌患者的临床资料,总结消化道类癌的临床表现,内镜及超声内镜特点及治疗和随访情况。结果消化道类癌的临床表现有:上腹不适(10/38),腹痛(7/38),腹泻(3/38),便血(2/38),排便习惯改变(12/38),左下腹不适(4/38);其中出现类癌综合征患者3例,均合并有肝转移。发病部位:食管1例,胃7例,小肠2例,回盲部2例,横结肠1例,乙状结肠1例,直肠24例。消化内镜检查发现病变37例,超声内镜检查33例(病变位于黏膜固有层或黏膜下层),腹部增强CT检查38例(其中小肠病变2例伴肠系膜转移,肝转移瘤3例)。经内镜下切除24例(病变直径<10mm,胃2例,直肠22例),手术治疗14例(食管1例,胃5例伴肝转移1例,小肠肿物伴肠系膜转移2例,回盲部2例,横结肠1例伴肝转移1例,乙状结肠1例,直肠2例伴肝转移1例);术前病理诊断类癌33例,5例为术后病理证实。结论消化道类癌临床表现缺乏特异性,合并肝转移患者可出现类癌综合征;消化道类癌内镜下组织活检进行免疫组化的病理诊断率很高;超声内镜是提高类癌拟诊及指导内镜下切除类癌病变的重要检查手段;内镜下病变切除及外科手术治疗是类癌的重要治疗手段。     

超声内镜细针穿刺术对非上消化道黏膜下肿物的诊断价值及误诊分析

目的探讨超声内镜(EUS)引导下细针穿刺术(EUS-FNA)对EUS误诊的非上消化道黏膜下肿物(SMT)病变的诊断价值,分析误诊原因。方法回顾性分析在我院就诊,并经常规胃镜初筛和EUS诊断为SMT,最后通过EUS-FNA取得病理组织确诊为非SMT的15例患者,比较EUS特征和最终诊断,分析误诊原因。结果 15例患者中肺腺癌2例、肺鳞癌2例、小细胞癌2例、恶性淋巴瘤1例、炎性团块1例、非特异度淋巴结炎2例、巨淋巴结增生病(Castleman病)1例、结核4例。所有患者均成功实施EUS-FNA并获取满意病理学标本,未发生穿孔及出血等并发症。结论 EUS下某些病变内部回声不均匀、上消化道层次不清晰、周围结构显示不清,易导致误诊,EUS-FNA能安全有效地鉴别肿物性质,从而避免误诊,指导治疗,具有较好的临床应用价值。     

直肠神经内分泌肿瘤的内镜下诊断与治疗

目的分析直肠神经内分泌肿瘤(R-NENs)的临床病理学特征,并探讨R-NENs内镜下的诊断特点及内镜下治疗的效果及安全性。方法回顾性分析2010年1月-2019年9月就诊于新疆医科大学第一附属医院并行常规结肠镜检查的76例R-NENs患者的临床资料,均经组织标本活检或手术切除瘤体病理检查明确诊断为R-NENs。结果肿瘤位于低位直肠段32例(42.11%),中段25例(32.89%),下段19例(25.00%)。36例行超声内镜(EUS)检查,其中27例EUS下诊断为R-NENs,2例诊断为间质瘤,6例诊断为脂肪瘤,1例诊断为平滑肌瘤,与病理结果诊断符合率达75.00%(27/36)。29例病例行内镜黏膜下剥离术(ESD),22例行内镜下黏膜切除术(EMR),20例行内镜经黏膜下隧道肿物剥离术(STER),2例行电凝电切术,3例因不同原因未通过上述内镜手术方式进行治疗。所有患者中69例行病理学检查及免疫组化检查,结果证实G1级最多见,共62例,占所有病例的81.58%(62/76)。结论R-NENs以男性多见,好发于中低位直肠段,其中G1级最为常见;EUS技术的成熟运用能够对病变性质及组织学起源进行较准确的判断,但也存在一定的误诊率,最终还应以病理结果为金标准;早期G1、G2级R-NENs经内镜治疗是安全有效的,并且能够提供较完整的病理学资料。     

内镜超声在食管黏膜下肿物临床诊疗中的应用价值

目的探讨内镜超声在食管黏膜下肿物(SMT)临床诊疗中的应用价值。方法回顾性分析该院113例胃镜下发现的食管SMT并行超声内镜(EUS)检查的患者,收集患者115处SMT病变的临床特点、内镜检查治疗和病理组织学结果等资料,并对术后患者进行随访。结果 SMT好发于食管上段44处(38.26%)和中段(38/115,33.04%);病理结果显示,84.35%为平滑肌瘤(97/115),另外5处食管囊肿(4.35%),5处黏膜下固有腺体增生伴导管扩张(4.35%),2处间质瘤(1.74%),2处脂肪瘤(1.74%),1处神经鞘瘤(0.87%),1处血管瘤(0.87%),1处浆液性腺瘤(0.87%),1处颗粒细胞瘤(0.87%);EUS诊断符合率分别为平滑肌瘤93.00%(93/100),食管囊肿55.50%(5/9),间质瘤0.00%(0/3),脂肪瘤100.00%(2/2),血管瘤100.00%(1/1)。EUS诊断起源于黏膜肌层者,主要选择内镜下黏膜切除术(EMR)(76.12%,51/67)和内镜黏膜下剥离术(ESD)(23.88%,16/67)治疗,起源于黏膜下层者,主要选择EMR(35.71%,5/14)和ESD(64.29%,9/14)治疗,起源于固有肌层或累及固有肌层者,多选择经内镜黏膜下隧道肿瘤切除术(STER)(84.85%,28/33)治疗。免疫组化结果示平滑肌瘤98.97%(96/97)平滑肌肌动蛋白(SMA)和97.94%(95/97)结蛋白(Desmin)表达阳性。结论 EUS对SMT的病理性质可进行较准确的诊断,并指导食管SMT内镜下微创手术方式的选择,能进行安全有效的治疗,但对食管间质瘤、神经鞘瘤等少见食管肿瘤的诊断具有一定的局限性。     

超声内镜检查术诊断消化道黏膜下病变的回顾性分析

目的 评估超声内镜检查术（EUS）诊断消化道黏膜下病变（SML）的临床价值。方法 回顾性分析2020年1月-2021年12月该院消化内科使用EUS诊断,并经组织病理学证实为SML患者的病例资料。结果 共有142例消化道SML患者进行了EUS检查。其中,135例为实体瘤,7例为壁外压迫。实体瘤中,EUS诊断黏膜层病变14例,黏膜肌层病变20例,黏膜下层病变62例,固有肌层病变39例,其诊断准确率分别为：100.0%、100.0%、95.0%和89.7%。EUS诊断平滑肌瘤30例（21.1%）,间质瘤29例（20.4%）,神经内分泌肿瘤25例（17.6%）,异位胰腺15例（10.6%）,息肉14例（9.9%）,脂肪瘤11例（7.7%）,囊肿9例（6.3%）,壁外压迫7例（4.9%）,颗粒细胞瘤2例（1.4%）。107例行内镜治疗或手术切除后送病检,99例病理与EUS诊断相符,EUS总体诊断准确率为92.5%。结论 EUS对消化道SML诊断的准确性与病变的起源有关,起源于黏膜层与黏膜肌层的诊断准确性最高,在鉴别壁内病变与壁外压迫方面,也具有较好的诊断价值。EUS在一定程度上可以判断SML的性...     

内镜黏膜下剥离术治疗胃肠道神经内分泌肿瘤的临床观察

目的探讨内镜黏膜下剥离术(ESD)在胃肠道神经内分泌肿瘤(GI-NENs)治疗中的安全性和有效性。方法回顾性分析该院2011年1月-2015年12月52例经ESD治疗的GI-NENs患者临床资料,总结其内镜下形态,记录完整切除率,并发症发生率,病理特征以及随访结果。结果 52例患者中胃16例,结肠9例,直肠27例;大部分病灶为黏膜下隆起,少数为不典型的息肉样改变;所有病灶均一次性整块切除病变,其中G1 44例,G2 8例;完整切除率94.23%(49/52);2例直肠病灶侵犯固有肌层,追加外科手术;1例直肠穿孔,内镜下处理及保守治疗好转。全组病例未出现大出血,术后平均随访22.6个月,1例胃病灶发生局部复发,行第二次ESD治疗,未发现淋巴结和远处转移病例。结论严格把握内镜治疗适应证,ESD治疗GI-NENs是可行、安全、有效的。     

超声内镜及内镜黏膜下剥离术对直肠类癌的诊疗价值

目的探讨超声内镜(EUS)对直肠类癌治疗的指导价值,及内镜黏膜下剥离术(ESD)对直肠类癌治疗的安全性及有效性。方法对临床考虑直肠类癌的患者进行EUS检查,根据EUS结果选择适合的治疗方案。结果 45例术前病理确诊的类癌病例,42例经ESD治疗,2例累及固有肌层及1例浸透浆膜层并伴有周围淋巴结转移者,经外科手术治疗。结论 EUS能够明确直肠类癌的大小、浸润深度、有无周围淋巴结肿大,对其治疗有较高的指导价值。对于小于20 mm直肠类癌,ESD是一种安全、有效的方法。     

The use of endoscopic ultrasound-guided fine-needle aspiration for investigation of submucosal and extrinsic masses of the colon and rectum

BACKGROUND AND STUDY AIM: Ensdoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been reported as a useful technique for histological diagnosis of submucosal or extrinsic gastrointestinal and pancreatic lesions. The aim of this study was to evaluate the use of EUS-FNA for the diagnosis of lesions either within or adjacent to the wall of the colon and rectum. PATIENTS AND METHODS: A total of 22 patients with a lesion within the wall of, or adjacent to, the colon or rectum underwent EUS-FNA. They were divided into two groups: patients who had previously had a malignancy (the "previous +ve" group, n = 11), and patients who had not previously had a malignancy (the "previous -ve" group, n = 11). In the four patients who had lesions located proximal to the sigmoid colon, EUS-FNA was performed using a guide wire and overtube. The success rates for adequate tissue sampling and for detecting malignant and benign masses by EUS-FNA were evaluated and the success rate for detection was compared with the success rate of EUS and computed tomography. RESULTS: Sufficient tissue for evaluation was obtained from 21 of the 22 patients (95.5 %). The overall rate of detection of malignant and benign masses was 95.5 % (21/22) for EUS-FNA and 81.8 % (18/22) for pre-EUS-FNA imaging investigations. Of the 11 patients in the previous +ve group, ten were diagnosed with recurrences of primary malignancies; of the 11 patients in the previous -ve group, four were diagnosed with primary malignancies and seven were diagnosed with benign lesions. There were no complications related to the EUS-FNA procedure. CONCLUSIONS: EUS-FNA is a safe technique which is useful in the planning of treatment for patients who have a mass within the wall or adjacent to the wall of the entire length of the colon or rectum.     

Localized colitis cystica profunda of the sigmoid colon

Localized colitis cystica profunda (CCP) is a rare condition found in the rectum. Localized CCP of 70-year-old man was found in the sigmoid colon, it was accompanied by a cancer in the ascending colon and an adenomatous polyp with focal malignancy in the sigmoid colon. Colonoscopically, the tumor appeared like a submucosal tumor.     

Rectosigmoid endometriosis: endoscopic ultrasound features and clinical implications

BACKGROUND AND STUDY AIMS: The main area of the gastrointestinal tract affected by deep pelvic endometriosis is the rectosigmoid colon in 3-37% of cases. Due to the risk of infiltration and the clinical symptoms of endometriosis, with pain and infertility, the condition may require surgical resection. Preoperative imaging diagnosis of rectosigmoid involvement is therefore important. Rectal endoscopic ultrasonography (EUS), which is already used for the staging of anorectal carcinoma and submucosal lesions, may be a promising technique for this indication. The present study was conducted in order to describe the endosonographic appearance of rectosigmoid endometriosis, and to define the potential relevance of the technique to the choice of resection method. PATIENTS AND METHODS: Between 1993 and 1997, 46 women (mean age 31) with deep pelvic endometriosis underwent imaging investigations and surgical resection. The clinical and imaging findings, and the surgical and histological features identified--mainly with regard to infiltration of the rectal wall--were compared retrospectively. The impact of the EUS findings on the decision on whether or not to carry out resection, either by laparoscopy or open abdominal surgery, was also examined. RESULTS: When there was deep pelvic endometriosis with suspected rectal wall infiltration, EUS showed normal anatomy in nine patients, endometriotic lesions without rectal wall infiltration in 12, and typical rectal infiltration in 25. The lesions were confirmed by the surgical findings during therapeutic laparoscopy (n = 22) and laparotomy (n = 25), as well as by clinical follow-up. Rectal wall infiltration, demonstrated in all cases using EUS, had initially been suspected on the basis of clinical examinations, rectoscopy, barium enema, computed tomography, and magnetic resonance imaging in 62%, 50%, 33%, 67% and 66% of cases, respectively. CONCLUSIONS: EUS is a simple and noninvasive technique capable of correctly diagnosing rectal wall infiltration in deep pelvic endometriosis. It may be helpful in determining the choice between laparoscopy and laparotomy when complete resection is indicated.     

改良的圈套器行内镜黏膜下剥离术切除结直肠息肉及黏膜下肿瘤的疗效评价

目的探讨改良的圈套器行内镜黏膜下剥离术(ESD)切除结直肠息肉及黏膜下肿瘤的安全性、有效性。方法回顾性研究2014年12月-2016年5月利用改良的圈套器完成ESD切除结直肠息肉、神经内分泌肿瘤(NETs)和间质瘤患者的临床资料,探讨改良的圈套器进行ESD术治疗结直肠病变的安全性、有效性、治疗时间和并发症等,并与HOOK刀完成ESD术进行比较。结果共20例病例24处入选并完成ESD术,其中16例病例共20处病灶均顺利完成改良的圈套器行ESD术(实验组),4例病灶采用传统HOOK刀完成ESD术(对照组)。两组手术成功率均为100.0%,病灶整块切除率100.0%(24/24);实验组息肉长径为1.2~4.0 cm,平均长径(2.4±0.9)cm,对照组息肉长径为1.5~3.0 cm,平均长径(2.2±0.6)cm;实验组手术时间为45.0~120.0 min,平均时间(83.3±23.9)min,对照组手术时间45.0~80.0 min,平均时间(66.2±15.4)min,与对照组比较,实验组耗时长,差异具有统计学意义(P=0.038)。术后病理:结直肠腺瘤15例(其中3例腺瘤伴局部腺体高级别上皮内瘤变),增生性息肉1例,高级别上皮内瘤变1例,NETs 2例共4处病灶,间质瘤1例,两组中除1例来源于固有肌层间质瘤全层切除术以外,无1例出现出血、穿孔、感染等并发症,无1例术中、术后转外科治疗。结论改良的单圈套器能够安全、有效地完成ESD术切除巨大结直肠息肉及黏膜下肿瘤,拓展了圈套器在内镜切除术中的使用方法及适应证,但需要更长时间来完成手术。     

内镜黏膜下剥离术治疗巨大结直肠侧向发育型肿瘤的临床研究

目的评价内镜黏膜下剥离术(ESD)治疗巨大结直肠侧向发育型肿瘤(LST)中的疗效和安全性。方法对150例病灶直径4 cm的结直肠LST的临床资料进行回顾性总结,分析LST形态分型、部位、病理结果、整块切除率、完全切除率和并发症。结果 150例患者中,颗粒型87例(58.0%),非颗粒型63例(42.0%)。部位分别为直肠109例(72.7%),乙状结肠13例(8.7%),降结肠5例(3.3%),横结肠8例(5.3%),升结肠13例(8.7%),盲肠2例(1.3%)。低级别上皮内瘤变23例,高级别上皮内瘤变104例,黏膜内癌7例,黏膜下癌16例。整块切除率为92.7%(139/150),完全切除率89.3%(134/150)。术中出血8.0%(12/150),术后出血1.3%(2/150),穿孔率为2.0%(3/150),术后狭窄2.0%(3/150)。结论非颗粒型巨大结直肠LST恶变率大。ESD治疗巨大结直肠LST是安全有效的。     

A study of intratumoral fibrous interstitium in the growth and proliferation process in rectal carcinoid tumors

The aim of the study was to investigate the relationship between the fibrous interstitium found in the spaces between tumor nests and the growth and proliferation process in 33 rectal carcinoid lesions (26 resected endoscopically and 7 resected surgically).The proportion of the tumor occupied by fibrous interstitium (F/T ratio) was measured in tissue specimens using an image analyzer, and the composition and distribution pattern of the fibrous interstitium were classified based on 21 lesions in which special staining was performed successfully. The results were then compared with tumor nest malignancy and preoperative endoscopic ultrasonography (EUS) findings for 23 lsions.The F/T ratio was significantly higher in the 16 lesions smaller than 5 mm and composed of low malignancy tumor nests (0.49 +/- 0.14) than in the 17 lesions 5 mm or larger (0.25 +/- 0.10). However, the F/T ratio was high (mean 0.41) for 2 of the 17 lesions 5 mm or larger comprised of highly malignant tumor nests.The fibrous interstitium was composed of part of the smooth muscle resulting from destruction of the muscularis mucosae and collagenous fibers. The 9 lesions with mixed interstitium in which smooth muscle predominated were comprised of low malignancy tumor nests with a significantly higher F/T ratio (0.55 +/- 0.09). In contrast, of the 12 lesions with separated interstitium, the 4 lesions in which collagenous fibers predominated had a significantly higher F/T ratio (0.34 +/- 0.05) than the 8 lesions in which smooth muscle predominated (0.18 +/- 0.05). Three of these 4 lesions had infiltrated as far as the deeper sections of the submucosal layer on EUS, and 1 of the lesions was a highly malignant tumor with an invasion depth of adventitia.THE EUS INTERNAL ECHO IMAGES OF THE TUMORS WERE CLASSIFIABLE INTO: (1) homogenous low-echoic; (2) honeycomb; (3) multiple high-echoic dots; and (4) unvisualized. These classifications reflected the tumor structure (structure of the dominant nest, F/T ratio, and fibrous interstitium distribution pattern) and depth of invasion.At the immature stage, there were large amounts of destroyed muscularis mucosae present in the spaces between the dispersed tumor nests. At the mature stage, the tumor nests formed a single solid mass, and in lesions that had infiltrated to the deeper sections of the submucosal layer or were highly malignant, the number of collagenous fibers inside the tumor increased, suggesting that fibrous interstitium is closely related to rectal carcinoid tumor growth and proliferation. These histologic findings can be predicted from EUS, and may therefore be useful in assisting preoperative diagnosis.