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...     

皮革胃的内镜诊断

１９９７年７月～１９９９年６月,我院检查胃镜１３６５０人次 ,查出进展期胃癌７３０例 ,检出率５．３５ % ,其中皮革胃３６例 ,占进展期胃癌的４．９ %。１．一般资料 :男２６例 ,女１０例 ,男∶女＝２．６∶１,年龄３７～７４岁 ,平均５７．５岁 ,病程１０天～１年 ,平均３个月。主要症状依次为上腹隐痛、腹胀、呕吐、进食受阻、消瘦、纳差 ,乏力、贫血、黑便、腹水、腹块等。２．内镜表现 :（１）病变部位 :累及全胃１６例（自贲门或胃底至胃窦） ,胃体 胃窦１４例 ,仅累及胃窦６例。（２）胃粘膜表现 :粘膜光滑伴充血 ,糜烂或出血似…     

内镜超声对食管胃底静脉曲张的诊断价值

目的探讨内镜超声检查术(EUS)对门静脉高压(PHT)所致食管胃底静脉曲张(EGV)的诊断价值。方法选择临床确诊PHT并存在EGV的患者53例及对照组20例,均进行电子胃镜和EUS检查,EUS检查主要了解EGV及其他异常静脉情况等。结果胃镜检出53例均有食管静脉曲张(EV),EUS检出29例；胃镜检出胃底静脉曲张(GV)者18例,EUS检出24例。两种方法检出率比较差异有统计学意义(P＜0．001)。EUS共检测出穿通支阳性患者27例(51%),穿通支显示情况在不同F值(内镜下EV形态分级)中的分布差异有统计学意义(P＜0．001)。EUS下监测脾静脉在实验组和对照组直径分别为(11．5±3．5)mm、(7．5±1．35)mm,差异有统计学意义(P＜0．001)。实验组和对照组奇静脉近端直径分别为(8．77±2．94)mm、(7．36±1．29)mm,差异有统计学意义(P＜0．05)。结论EUS对PHT所致的食管胃底静脉曲张有较大的辅助诊断价值,尤其对管壁外的异常静脉检出有重要价值。     

共聚焦显微内镜对临床难以确诊的皮革胃的诊断价值

目的探索共聚焦显微内镜（CLE）对临床难以确诊的皮革胃病例的诊断价值。方法收集2009年-2011年因胃黏膜病变行CLE检查的患者317例。CLE检查过程中使用经静脉注射的10％荧光素钠溶液作为荧光剂,术后行导向病理活检。对CLE无法确诊的病例行腹部薄层增强CT扫描,对符合手术指征者行外科手术。将普通胃镜、CLE检查及活检病理结果进行比较分析。结果总共13例临床确诊为皮革胃的患者接受了CLE检查,所有患者术前均曾接受包括常规内镜及活检病理在内的辅助检查,病理均未确诊胃癌。单纯根据CLE图像诊断皮革胃的准确率为76．9％（10／13）,CLE导向活检阳性率84．6％（11／13）。对皮革胃患者的CLE图像分析显示,腺体排列紊乱伴明显炎症反应、荧光素钠大量渗出、高度异型腺体或成片排列的大型暗色细胞、腺上皮或间质中大型浅色细胞、间质中异常扭曲异型的阳性率分别为84．6％、76．9％、76．9％、46．1％与7．7％。结论CLE检查及CLE导向活检术是提高皮革胃诊断正确性的有效方法。     

皮革胃的诊断研究进展

皮革胃是一种特殊类型的进展期胃癌,其肿瘤组织起源于黏膜下层,沿黏膜下层浸润性生长.由于皮革胃起病隐匿,无特异性症状和体征,并缺乏特异性辅助检查方法,故诊断较为困难,需多种检查方法联合诊断.皮革胃的病程发展迅速,患者的预后较差.该文就皮革胃的定义及诊断的研究进展作一综述,旨在提高临床医师对皮革胃的认识及诊治水平.     

皮革胃内镜下超声微探头特征分析

我院采用内镜超声微探头（miniprobe sonography，MPS）诊断皮革胃（Borrmann Ⅳ型胃癌），分析皮革胃的超声微探头的特征，结合临床判断皮革胃的切除可能性，现报道如下。     

内镜超声检查诊断胃原发性淋巴瘤的临床价值

目的 探讨EUS对胃原发性淋巴瘤(PGL)诊断、鉴别诊断及随访的临床价值.方法 对26例内镜形态学高度可疑为PGL的患者进行EUS探查,并根据其影像特征对病变性质做出判断,将EUS判断与常规内镜活检及常规内镜活检结合EUS指导大块活检结果进行比较分析.结果 与活检及手术病理组织学对照,EUS正确判断23例,2例PGL误诊为胃癌,1例胃癌误诊为PGL.EUS诊断符合率明显高于常规内镜活检(88.5%比50.0%,P=0.006),而略低于常规内镜活检结合EUS指导大块活检(92.3%,P=1.000),EUS对胃恶性病变与炎性巨大胃黏膜皱襞的鉴别诊断符合率达100.0%.EUS对浸润深度(T分期)的判断准确率为100.0%(12/12).结论 EUS可有效鉴别PGL及其他胃内溃疡或增殖性病变,对其治疗、随访具有重要作用.     

超声内镜对胃黏膜增厚性疾病的诊断价值

目的 探讨超声内镜对胃黏膜增厚性疾病的诊断价值,提高其诊断准确率.方法 对25例胃镜检查发现的胃黏膜增厚的患者行超声内镜检查,分析其内镜表现及超声影像特征.结果 超声内镜可以清楚显示胃壁的厚度及回声变化,对胃黏膜增厚疾病良恶性诊断的符合率为100%,对皮革胃的诊断符合率为94.8%;内镜活榆病理对恶性胃黏膜增厚诊断率为47.6%.超声内镜对恶性胃黏膜增厚疾病的诊断符合率与内镜活检比较有统计学意义(P<0.01).结论 超声内镜对胃黏膜增厚性疾病良恶性的鉴别具有重要的诊断意义,对于皮革胃和淋巴瘤,超声内镜是除手术病理鉴别外最重要鉴别诊断手段.     

内镜超声检查对胆囊癌的诊断价值

目的探讨内镜超声检查(EUS)对胆囊癌的诊断价值。方法对18例胆囊癌患者行EUS 检查并与体表B超(B超),X线电子计算机断层扫描(CT)/磁共振成像(MRI)结果进行比较。结果18例中EUS诊断17例,CT/MRI诊断15例,B超诊断5例。EUS诊断胆囊癌的敏感性与准确性高于B超,与CT/MRI相当。13例行手术治疗,与手术病理组织检查比较,EUS诊断正确率为92％,CT/MRI为76.9％,差异无显著性(P＞0.05)。B超为41.6％,差异有非常显著性(P＜0.01)。EUS对小病灶的显示明显优于B超,并优于CT/MRI。结论EUS对胆囊癌有较高的诊断价值。     

Primary linitis plastica of the rectum

Five cases of primary linitis plastica of the rectum are presented. The clinical, radiologic, and pathologic features of the disease are described with emphasis on the difficulty in establishing a correct preoperative diagnosis. Because the histologic features of primary and secondary linitis plastica are indistinguishable and because secondary involvement is twice as common as primary, it is mandatory that other sites of origin are excluded and that both the proximal and distal margins of the resected area be free of tumor. Read at the joint meeting of the American Society of Colon and Rectal Surgeons and the Royal Society of Medicine, London, England, June 18 to 20, 1979.     

Colorectal linitis plastica

Primary linitis plastica of the colon is an uncommon tumor, with only 22 cases having been previously reported. Experience with two men and one woman between 17 and 55 years of age, portraying a spectrum of clinical presentations ranging from rectal bleeding to large-bowel obstruction, is reviewed. Clinical and radiologic characteristics and histologic features helpful in making the diagnosis are detailed. Though the prognosis is grim, resective surgery, including oophorectomy in women, should be undertaken. Adjuvant therapy has been disappointing.     

以活检后溃疡不愈合为特征的皮革胃1例报道

皮革胃发病率低,临床表现不典型。现将我院收治的1例皮革胃患者报道如下。     

Endoscopic ultrasonography in rectal linitis plastica

Background: Rectal linitis plastica (RLP) is a rare tumor with a poor prognosis. RLP can be a primary tumor, secondary to gastric linitis, or a metastatic form of breast or prostate carcinoma. Diagnosis is difficult because of nonspecific clinical and endoscopic findings and frequent negative biopsies (50%). The aim of this study was to evaluate the endosonographic appearance of RLP and to study the usefulness of endoscopic ultrasonography (EUS) in the follow-up of patients with RLP. Methods: Twenty-two video-recorded EUS examinations performed in 11 patients with histologically proven RLP were retrospectively studied. Response to conservative treatment was evaluated in three patients with secondary RLP. Results: In every case of RLP, EUS showed a circumferential thickening of the rectal wall (mean 13 mm); the thickening was mainly seen in the submucosa and the muscularis propria. In nine cases EUS showed signs of locoregional involvement (perirectal fat infiltration [n = 6], ascites [n = 5], lymph nodes [n = 3]) which was not seen by CT. In follow-up evaluations, EUS showed a lack of response to treatment in two patients with RLP secondary to gastric linitis. In the remaining patient with RLP secondary to breast carcinoma, EUS at first showed no response. The chemotherapy protocol was modified, and then improvement became evident at EUS. Conclusions: RLP shows typical features of rectal EUS that may assist in the diagnosis of this rare disease. Moreover, EUS can be useful in evaluating the response of this disease to treatment. (Gastrointest Endosc 1997;46:532-6.)     

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.     

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.     

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。     

Endoscopic and echoendoscopic findings in secondary linitis plastica of the rectum

Linitis plastica of the rectum consists of intraparietal, subepithelial and circumferential tumoral infiltration of the wall of the rectum leading to a constricted rectum with mural thickening. There is often a delay between symptom onset and diagnosis because this entity mimics a large number of diseases and the findings of endoscopy and conventional biopsies are non-conclusive since the surface mucosa is not usually affected. We present the endoscopic and echoendoscopic findings of two patients with secondary linitis plastica of the rectum.