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...     

284例内镜超声检查与治疗分析

目的 探讨内镜超声诊断与治疗价值.方法 284例黏膜隆起性病变和胰腺疾病采用日本PentaxEG-3630u型超声内镜,探头频率5.0～7.5 MHz,纵轴电子线阵扇扫.结果 食管63例(平滑肌瘤30例,炎症6例,息肉4例,癌症6例,食管囊肿1例,外压9例),胃169例(胃炎67例、间质瘤40例、平滑肌瘤3例、癌症14例、息肉9例、脂肪瘤6例、胃溃疡2例、胃底静脉瘤2例、异位胰1例、外压25例),十二指肠16例(息肉6例,炎症1例,间质瘤3例,异位胰2例,外压1例),胰腺36例(肿瘤11例,炎症9例,假性囊肿4例,囊腺瘤1例).治疗息肉电切治疗14例,良性肿瘤套扎治疗13例.胰腺穿刺注射治疗5例,腹腔神经丛注射治疗2例,疼痛可暂时缓解.手术病理与内镜超声诊断符合率为96.3%.结论 该组黏膜隆起性病变患者中食管平滑肌瘤和胃间质瘤多见,超声图像和发生部位有助诊断.癌症、异位胰腺、脂肪瘤或脂肪肉瘤、静脉瘤、腔外压迹、扁平息内、炎性增生等内镜超声表现特点清晰,易于诊断处理.胰腺疾病内镜超声可提高早期诊治率.     

十二指肠隆起性病变的超声内镜诊断

目的探讨超声内镜(EUS)对十二指肠隆起性病变的诊断价值。方法对56例常规胃镜发现的十二指肠隆起性病灶进行超声内镜检查。结果发现息肉10例,黏膜炎性隆起1例,十二指肠Brunner腺瘤23例,间质瘤12例,脂肪瘤1例,胆囊外压3例,十二指肠乳头癌5例,十二指肠淋巴瘤1例。结论EUS能清晰显示消化道管壁层次结构及相邻器官组织结构,对十二指肠隆起性病变定性诊断有很高的价值。     

1例十二指肠壶腹部印介细胞癌病人的护理

胰、十二指肠肿瘤近年来的发病率逐渐上升,已成为我国人口死亡的十大恶性肿瘤之一。胰十二指肠切除术（Whipple术）是治疗胰头癌、壶腹部恶性肿瘤包括胆总管下段癌、壶腹周围癌、十二指肠恶性肿瘤等的主要手术方法之一,手术切除范围包括胰头、远端胃、十二指肠、空肠上段约12cm、胆囊和胆总管,同时清除相关淋巴结,再行肝总管、胰、胃与空肠重建消化道。     

超声内镜及微超声探头对胃外压性隆起的诊断价值

目的评价超声内镜（ＥＵＳ）及微超声探头（ＵＳＰ）对胃外压性隆起的诊断价值。方法对８６例胃外压性隆起灶进行了ＥＵＳ检查，９例进行了ＵＳＰ检查。结果①胃外压性隆起中脾脏压迫最多见，占５４．７４％，其余为肿大胆囊、肝右叶囊肿、肝左叶癌、左肾、胰腺囊腺瘤和胰腺囊肿；②ＥＵＳ对胃外压性隆起的诊断正确率达１００％，其对外压灶的完全显示率高于微超声探头；③良性胃外压灶及多数恶性肿瘤胃外压灶其所压胃壁结构均正常；④脾脏压胃者中脾肿大仅占３８．４６％，且均为轻、中度脾肿大；⑤胃隆起部位与外压灶的种类相关联。结论超声内镜及微超声探头诊断胃外压性隆起灶具有较高的价值     

超声内镜检查在胃底隆起性病变诊断中的应用价值

目的评价超声内镜检查（EUS）对胃底隆起性病变的诊断价值。方法对经胃镜诊断的215例胃底隆起性病变患者进行EUS,通过观察,比较其起源、大小、回声、境界等,得出诊断。结果 215例病变中诊断间质瘤101例、胃外压迫72例、静脉曲张20例、息肉9例、黏膜皱襞5例、脂肪瘤2例、血管瘤2例、囊肿2例、神经纤维瘤1例、异位胰腺1例。结论 EUS对胃底隆起性病变有独特的诊断及鉴别诊断价值,并有助于指导选择病灶的治疗方案。     

经胃内镜超声引导下胰腺假性囊肿管型刀电切造瘘治疗

目的通过内镜超声（EUS）引导下经胃对胰腺囊肿进行电切造瘘，来达到充分引流囊肿、避免感染和囊肿复发的目的，并评价该方法的安全性。方法研究对象为25例胰腺囊肿患者，其中男11例，女14例，囊肿平均直径8cm（5～12cm），胰头部囊肿3例，胰体部、胰尾部囊肿各11例，应用大腔道超声内镜进行EUS检查，选择合适的穿刺位置，将穿刺针刺入囊肿中心，将导丝置入囊内，沿导丝插入10F管型高频电切刀对胃壁和囊壁实施高频电切造瘘，电切完成后沿导丝置入10F双猪尾支架。术后临床观察，1周后复查CT和EUS，以后每个月复查CT1次。结果全部患者均未发生感染、出血、穿孔等并发症，术后1周时，24例患者CT检查囊肿基本消失，1例患者囊肿明显缩小，2个月后消失。内镜下见瘘道通畅，痿道直径0．8～1．5cm，术后随访3个月后拔出引流管，随访6～10个月未见囊肿复发。讨论EUS引导下经胃对胰腺囊肿管型刀电切造瘘治疗是治疗胰腺囊肿快速有效的方法，并且这种方法是安全的。     

跟踪电话随访对胰十二指肠切除术后带管出院患者自我护理能力的影响

正胰十二指肠切除术是治疗胰头癌、十二指肠乳头癌、胆总管下段癌、壶腹癌的有效手段,手术切除范围包括部分胰头部、胆总管及胆囊、十二指肠、空肠上端和胃幽门区,手术内容还包括相关脏器周围的淋巴结清除、消化道重建等。胰十二指肠切除术是腹部外科最为复杂的手术之一,术后引流管多,对术后护理提出     

胰头癌和壶腹癌的多层螺旋CT诊断

目的：评价多层螺旋CT在胰头癌和壶腹癌诊断中的作用。方法：回顾性分析39例经手术病理确诊的胰头癌和壶腹癌患者的多层螺旋CT表现，其中胰头癌29例，壶腹癌10例，男24例，女15例，年龄39~81岁。应用Siemens Sensation 4层和16层CT，进行增强前后多期扫描。在原始横断面图像基础上结合多层面重建及其它后处理，对两组疾病的多层螺旋CT表现进行总结、比较，统计CT术前诊断的准确性。结果：本组病例的CT主要表现：①壶腹癌瘤体小，易向十二指肠腔突出，中心位于十二指肠腔内；胰头癌的中心则通常在胰腺内。②肿瘤与胆胰管、胰周血管的关系均可清晰显示。③两管靠近（扩张的胆胰管末端间距≤5mm）多见于壶腹癌，而两管分离（扩张的胆胰管末端间距＞5mm）多见于胰头癌。胰头癌和壶腹癌的多层螺旋CT肿块显示率分别为96.6%和90%，术前诊断准确率分别为93.1%和90%。结论：多层螺旋CT可以展现胰头癌和壶腹癌的影像特征，对术前诊断和分期有较高的价值。     

超声内镜引导经胃内引流术治疗胰腺假性囊肿误吸的预防

目的探讨如何预防在超声内镜(EUS)引导下经胃内治疗胰腺假性囊肿引起的误吸。方法对该院所做的EUS引导下经胃内引流胰腺假性囊肿的资料进行回顾性分析。结果 16例胰腺假性囊肿患者,经EUS引导胃内穿刺放置内支架引流成功16例,穿刺引流操作成功率为100.0%。囊肿完全吸收16例,治愈率100.0%。穿刺后囊液反流导致误吸2例,发生率为12.5%。3例患者通过内镜拔出引流支架,另外13例患者支架自行脱落排出。结论头高脚低位、精细操作及食管套管可以防止EUS穿刺后胰腺假性囊肿囊液误吸入气管。     

内镜超声诊断上消化道及胆胰疾病(291例报告)

目的　探讨内镜超声 (EUS)对上消化道及胆胰疾病的诊断价值。方法　采用Pentax彩色多普勒线阵型内镜超声 ,对 2 91例有不同上消化道及胆胰疾病的症状 ,并经有关特殊检查未能诊断者进行检查。结果　 2 91例中检出食管、胃黏膜病 2 9例、黏膜下隆起病变 98例、食管癌 9例、胃及贲门癌 2 5例、纵隔肿瘤 2例和胆胰疾病 12 8例 ,其总诊断正确率为 97.6% (2 84/2 91)。结论　EUS对上消化道及胆胰疾病诊断有较好的临床价值。     

多种影像学检查对胰腺癌的诊断价值

目的　比较超声内镜（EUS）、体表B超（US）、CT和ERCP对胰腺癌的诊断价值。方法　对180例经超声内镜（EUS）诊断的胰腺癌中具有手术病理诊断,又同期进行过以上各项检查的60例完整的病例进行分析。结果　EUS对胰腺癌的诊断敏感性为90%,特异性为70%,均高于US、CT和ERCP;EUS对胰腺癌TNM各期（T1～T4）的评价能力均高于US、CT和ERCP,分别达T1&T2=50%,T3=62%,T4=90%,总计达75%,对N因素的敏感性为46%,特异性为85%,也高于其他影像检查。结论　EUS联合US、CT及ERCP对胰腺癌的早期诊断及TNM分期均有较高的价值。     

Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions

This article provides an overview of the histopathologically defined nonneoplastic and neoplastic entities involved in submucosal lesions (SMLs) of the gastrointestinal tract, particularly those in the upper gastrointestinal tract. The gross appearance and the histomorphological and cytomorphological features of the most frequent SMLs are described, including gastrointestinal stromal tumor (GIST), leiomyoma, lipoma, carcinoid, granular-cell tumor, glomus tumor, schwannoma, submucosal metastases, Brunner's gland hamartoma, pancreatic rests, and cysts. The current state of important technical aspects of biopsy processing and the role of histology and cytology in the diagnosis of SMLs are discussed.     

Pancreatic endosonography after Billroth II gastrectomy

BACKGROUND AND STUDY AIMS: Prior Billroth II gastrectomy is considered a relative contraindication to endoscopic ultrasonography (EUS) of the pancreatic head. This study reviews experience with pancreatic EUS in such patients. PATIENTS AND METHODS: Eleven patients were identified who had previous Billroth II gastrectomy and underwent attempted pancreatic EUS. RESULTS: Examination of the pancreatic head was technically feasible in 10 of the patients. The inferior pancreatic head, ampulla, and periampullary ducts were seen in all; the superior pancreatic head and porta hepatis were visualized in 50 % of cases with radial echo endoscopes and 100 % with a linear-array echo endoscope. The pancreatic neck was fully imaged in 25 % of cases with radial echo endoscopes and in 60 % with a linear-array echo endoscope. One known pancreatic neck mass was not visualized. CONCLUSIONS: Pancreatic EUS is technically feasible in most patients with a prior Billroth II gastrectomy. Linear-array echo endoscopes provide a more complete examination than radial echo endoscopes. The pancreatic neck may be difficult to visualize.     

经腹超声引导下经皮穿刺活检对内镜超声引导下穿刺活检诊断胰腺肿瘤的补充价值

目的 观察经腹超声引导下经皮穿刺活检对内镜超声(EUS)引导下穿刺活检诊断胰腺肿瘤的补充价值。方法 回顾性分析30例因EUS引导下穿刺活检诊断结果不满意(未见肿瘤细胞20例、可见异常细胞但无法明确诊断10例)而接受经腹超声 引导下经皮穿刺活检的胰腺肿瘤患者,评价后者的补充诊断价值。结果 20例EUS引导下穿刺活检未见肿瘤细胞患者中,经腹超声引导下穿刺活检明确诊断11例肿瘤及其病理类型,7例可见异常细胞但未能明确诊断,2例仍未见肿瘤细胞;10例EUS引导下穿刺结果无法明确诊断患者中, 经腹超声引导下穿刺活检明确诊断9例肿瘤及其病理类型,1例为非典型细胞。结论 经腹超声引导下经皮穿刺活检对EUS引导下穿刺活检诊断胰腺肿瘤具有较高补充价值。     

超声胃镜在上消化道隆起病变诊断与治疗中的价值

目的 探讨超声胃镜对上消化道隆起性病变的诊断与治疗价值.方法 应用超声胃镜对118例上消化道隆起性病变患者进行检查及引导治疗.结果 118例上消化道隆起病变位于食管38例,其中食管平滑肌瘤23例、食管平滑肌肉瘤2例、食管息肉4例、食管囊肿2例、食管癌3例、食管孤立性静脉瘤1例、食管脂肪瘤1例、食管腔外压迫2例;位于胃80例,其中胃间质瘤26例、胃平滑肌瘤14例、胃脂肪瘤4例、胃底静脉瘤2例、异位胰腺4例、胃壁外压迫26例、未见异常4例,胃壁外压迫病变主要为脾脏（16/26,61.5％）,其次是肝左叶、胆囊、胰腺囊肿、胰腺囊腺癌等.118例中行内镜下手术治疗45例,有3例（6.6％）发生创面边缘少量渗血,无一例发生大出血及穿孔等严重并发症;术后随访38例,创面均已愈合良好,无复发病例.术后病理确诊41例,超声胃镜与手术病理结果符合率为91.1％（41/45）.结论 超声胃镜诊断上消化道黏膜下隆起性病变较为准确,能对病变的性质及起源做出诊断,并对治疗方法的选择提供参考.     

Endoscopic ultrasonography in the diagnosis of depth invasion and lymph node metastasis of carcinoma of the papilla of Vater

To evaluate diagnostic accuracy of endoscopic ultrasonography (EUS) on the extent of carcinoma of the papilla of Vater, 28 patients were preoperatively evaluated using our EUS grading system. EUS was accurate in diagnosing carcinoma infiltration into the duodenal proper muscle layer (100%) and into the pancreas (75%). When compared with postoperative histologic findings, the overall accuracy of EUS in assessing local infiltration was 89.3%. Misdiagnoses occurred in three cases due to microinfiltration of the carcinoma. Lymph node metastasis around the pancreatic head was accurately diagnosed in nine cases; however, mesenteric lymph node metastasis could not be detected in four cases because the tumor was far from the scanning site.     

Do manual chest compressions provide substantial ventilation during prehospital cardiopulmonary resuscitation?

IntroductionChest compressions have been suggested to provide passive ventilation during cardiopulmonary resuscitation. Measurements of this passive ventilatory mechanism have only been performed upon arrival of out-of-hospital cardiac arrest patients in the emergency department. Lung and thoracic characteristics rapidly change following cardiac arrest, possibly limiting the effectiveness of this mechanism after prolonged resuscitation efforts. Goal of this study was to quantify passive inspiratory tidal volumes generated by manual chest compression during prehospital cardiopulmonary resuscitation.Materials and methodsA flowsensor was used during adult out-of-hospital cardiac arrest cases attended by a prehospital medical team. Adult, endotracheally intubated, non-traumatic cardiac arrest patients were eligible for inclusion. Immediately following intubation, the sensor was connected to the endotracheal tube. The passive inspiratory tidal volumes generated by the first thirty manual chest compressions performed following intubation (without simultaneous manual ventilation) were calculated.Results10 patients (5 female) were included, median age was 64 years (IQR 56, 77 years). The median compression frequency was 111 compression per minute (IQR 107, 116 compressions per minute). The median compression depth was 5.6 cm (IQR 5.4 cm, 6.1 cm). The median inspiratory tidal volume generated by manual chest compressions was 20 mL (IQR 13, 28 mL).ConclusionUsing a flowsensor, passive inspiratory tidal volumes generated by manual chest compressions during prehospital cardiopulmonary resuscitation, were quantified. Chest compressions alone appear unable to provide adequate alveolar ventilation during prehospital treatment of cardiac arrest.     

Assessment of CPR interruptions from transthoracic impedance during use of the LUCAS™ mechanical chest compression system

BackgroundQuality of cardiopulmonary resuscitation (CPR) is a key determinant of outcome following out-of-hospital cardiac arrest (OHCA). Recent evidence shows manual chest compressions are typically too shallow, interruptions are frequent and prolonged, and incomplete release between compressions is common. Mechanical chest compression systems have been developed as adjuncts for CPR but interruption of CPR during their use is not well documented.AimAnalyze interruptions of CPR during application and use of the LUCAS? chest compression system.Methods54 LUCAS 1 devices operated on compressed air, deployed in 3 major US emergency medical services systems, were used to treat patients with OHCA. Electrocardiogram and transthoracic impedance data from defibrillator/monitors were analyzed to evaluate timing of CPR. Separately, providers estimated their CPR interruption time during application of LUCAS, for comparison to measured application time.ResultsIn the 32 cases analyzed, compressions were paused a median of 32.5 s (IQR 25–61) to apply LUCAS. Providers’ estimates correlated poorly with measured pause length; pauses were often more than twice as long as estimated. The average device compression rate was 104/min (SD 4) and the average compression fraction (percent of time compressions were occurring) during mechanical CPR was 0.88 (SD 0.09).ConclusionsInterruptions in chest compressions to apply LUCAS can be <20 s but are often much longer, and users do not perceive pause time accurately. Therefore, we recommend better training on application technique, and implementation of systems using impedance data to give users objective feedback on their mechanical chest compression device use.