超声内镜对食管癌的诊断价值

应用超声内镜（EUS）对23例食管癌患者进行T分期诊断。结果表明：EUS诊断癌的浸润深度与病理诊断的总符合率为83．75％；EUS诊断淋巴结转移与病理诊断的符合率为80％。EUS对食管癌手术治疗的方式有重要意义，将成为术前重要的检查手段。     

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.     

胰腺癌及壶腹周围癌的超声内镜声像特征分析

目的旨在探讨胰腺癌及壶腹周围癌的超声内镜(endoscopic ultrasonography，EUS)声像特征及诊断价值。方法回顾性分析经EUS检查并由病理检查诊断的42例胰腺癌及12例壶腹周围癌，对两类疾病的声像图特征及诊断正确率进行归纳总结。结果EUS对胰腺癌及壶腹周围癌的诊断具有较高的准确性，胰腺癌的诊断准确率为95．2％。壶腹周围癌的诊断准确率为83.3％。EUS对两类肿块的显示率均达100％。胰腺癌中胰腺呈局限性肿大37例(88．1％)，病灶呈低回声33例(78．6％)，伴胆管扩张29例(69．0％)，伴胰管扩张26例(61.9％)：壶腹周围癌中肿块呈低回声的10例(83.3％)，稍强回声的2例(16．7％)，伴肝内外胆管扩张12例(100．0％)，伴胰管扩张7例(58．3％)。结论EUS对胰腺癌及壶腹周围癌均有较高的诊断价值。     

胆总管下段癌的腔内超声与ERCP诊断价值比较

目的比较内镜超声(EUS)、胆管腔内超声(IDUS)与内镜下逆行胰胆管造影(ERCP)对胆总管下段癌的诊断价值.方法回顾分析上海长海医院1999年8月至2003年8月期间,同期施行EUS、IDUS和ERCP检查,并经手术标本病理证实的42例胆总管下段癌患者的病例资料,比较EUS、IDUS和ERCP的诊断价值.结果 42例患者中,男24例,女18例,平均年龄53.9岁.EUS检出39例(92.9%),IDUS检出42例(100%),ERCP检出40例(95.2%),三者检出率差异无统计学意义(P>0.05).EUS漏检的3例病灶均局限于胆管壁,但被IDUS确诊.结论 EUS与ERCP对胆总管下段癌具有相当的检出率, EUS和ERCP联合IDUS可提高早期胆总管下段癌的诊断水平.     

超声内镜对胃癌术前分期的临床意义

目的探讨超声内镜对胃癌术前分期的意义。方法对69例胃癌患者进行术前内镜超声检查,并与术后组织病理分期比较。结果在判断胃癌浸润深度T分期上,EUS总的正确率36.2%,其中T1m41.7%,T1sm75%,T2mp100%,T3se66.7%,T4si25%;在判断淋巴结转移N分期上,EUS总的正确率62.3%,其中N-100%,N+53.8%。结论EUS对胃癌术前T及N分期具有重要意义,但是如何避免分期过深或过浅、如何鉴别良恶性淋巴结方面,尚需进一步探讨。     

内镜超声检查在肺癌中的应用

目的评价内镜超声（endoscopic ultrasonography，EUS）检查在肺癌的应用价值。方法采用Pentax FG-36UX内镜经食管超声检查肺癌32例。结果对32例肺癌患者EUS检查既了解病变纵隔浸润情况、纵隔病变与周围脏器的关系，又明确纵隔淋巴结转移数目，EUS检查肺癌纵隔浸润的准确率为87％，行内镜超声引导下细针吸取细胞学检查（endosonography—guided fine needle aspiration，EUS FNA）15例，阳性率86％、准确率为100％。结论EUS是一项先进、安全、对肺癌临床诊断有较大帮助的检查手段。     

The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer

Accurate staging of pancreatico-biliary cancer is essential for surgical planning and for identification of locally advanced and metastatic disease that is incurable by surgery. The complex regional anatomy of the pancreatico-biliary system makes histologic diagnosis of malignancy at this region difficult. The ability to position the endoscopic ultrasound transducer at endoscopy in direct proximity to the pancreas and the bile duct, combined with the use of fine-needle aspiration, enables accurate preoperative staging of cancer, especially cancer too small to be characterized by CT or MRI. Endoscopic ultrasonography (EUS) identifies patients unlikely to be cured by surgery due to vascular invasion or regional nodal metastasis, thereby limiting procedure-related morbidity and mortality. This article focuses on the utility and recent advances of EUS in the evaluation of pancreatico-biliary cancer.     

Role of endoscopic ultrasonography in prevention of unnecessary endoscopic retrograde cholangiopancreatography: a prospective study of 150 patients.

OBJECTIVE: The purpose of this study was to evaluate the impact of substituting endoscopic ultrasonography (EUS) for endoscopic retrograde cholangiopancreatography (ERCP) in cases of a low to intermediate risk for choledocholithiasis. METHODS: During a 16-month period, patients who were referred for suspected choledocholithiasis, biliary colic, or acute biliary pancreatitis on the basis of alterations in liver enzyme values with or without gallstones seen on transabdominal ultrasonography were included. Endoscopic ultrasonography was performed for all patients. Patients with common bile duct stones underwent ERCP. Cholecystectomy was recommended in all patients with symptomatic gallstones. Cases were followed for 12 months. RESULTS: A total of 150 patients were included. Choledocholithiasis was diagnosed by EUS in 39 patients (26.0%) and was confirmed by ERCP in 30 (77.0%). Fifty-one patients had a normal common bile duct, and follow-up for 12 months showed no abnormalities except in 1 patient. Cholecystectomy without ERCP was recommended for the remaining 60 patients who had symptomatic gallstones or sludge. Endoscopic retrograde cholangiopancreatography was avoided by this approach in 110 patients (73.3%). CONCLUSIONS: In a low to intermediate risk for choledocholithiasis, EUS can preclude the need for ERCP in most cases.     

超声内镜对胰腺疾病的诊断

本文报告超声内镜（ＥＵＳ）对５０例胰腺癌及３０例慢性胰腺炎的诊断，并与ＵＳ、ＥＲＣＰ和ＣＴ进行了对比研究。结果表明：①ＥＵＳ对胰腺癌的显示率达１００％，诊断正确率达９４％，高于ＵＳ、ＣＴ和ＥＲＣＰ。②ＥＵＳ对胰腺癌术前被膜浸润、胰后方组织浸润、淋巴结转移和门脉浸润的诊断正确率分别为７２％、７４％、７６％和８０％。③ＥＵＳ显示主胰管与ＥＲＣＰ，相近．对胰石和囊肿的发现率优于ＥＲＣＰ。④ＥＵＳ能对胰实质回声改变进行分型诊断。⑤ＥＵＳ与ＵＳ和／或ＥＲＣＰ联合检查可提高慢性胰腺炎的正确诊断率。     

高频微探头超声内镜检查在结直肠癌术前TN分期中的价值

目的:探讨高频微探头超声内镜(EUS)检查在结直肠癌TN分期中的价值.方法:145例结直肠癌患者术前采用高频微探头EUS检查进行TN分期,并与术中探查和术后病理检查结果进行比较.结果:结直肠癌患者术前高频微探头EUS检查的T、N分期与术后病理分期符合率分别为84.83％和70.34％,其中T1、T2、T3、T4期的符合率分别为88.89％、85.71％、84.27％和80.00％.对有无淋巴结转移的诊断符合率较高,分别为98.41％(N+)、92.68％ (N0).N1、N2分期的符合率分别为76.92％和16.22％.结论:高频微探头EUS检查能较准确地判断结直肠癌的浸润深度(T分期),尤其适用于早期结直肠癌和癌性狭窄患者的术前分期;对有无淋巴结转移判断较准确,对N分期,尤其N2分期准确性有待提高.     

内镜超声结合E-钙粘素和CD44v6检查在食管癌诊断中的价值

目的　探讨术前内镜超声检查 (EUS)及E -钙粘素 (E -CD)、CD4 4v6表达在食管癌术前分期诊断中的价值。方法　对 5 8例食管鳞癌患者术后标本应用SP法检测E -CD和CD4 4v6的表达 ,对其中 30例食管鳞癌患者术前进行了EUS。结果　EUS诊断食管鳞癌术前TNM分期与术后病理分期对照 ,其T期总的准确率为 83% ,N期总的准确率为 77%。E -CD、CD4 4v6阳性表达率与食管鳞癌患者肿瘤细胞浸润深度、淋巴结转移显著有关 (P <0 .0 1) ,与食管癌患者临床分期有关 (P <13.0 5 )。但在食管鳞癌原发灶中E -CD和CD4 4v6表达无相关性 (P >0 .0 5 )。食管癌患者中UESTN分期与E -CD、CD4 4v6阳性表达率显著相关 (P<0 .0 1)。结论　E -CD和CD4 4v6均可反映食管癌生物学行为的指标 ,将两种细胞粘附分子的检测与EUS结合起来 ,能更准确地对食管癌患者进行TNM分期。     

超声诊断肝外胆管癌的价值

目的分析肝外胆管癌的声像图特点,探讨早期超声诊断的临床价值。方法50例超声拟诊为肝外胆管癌患者,经临床手术、其他影像学及(或)经皮胰胆管逆行造影证实,分析其患者临床及超声影像学资料。结果肝外胆管癌超声直接征象分为乳头型、团块型、截断型和狭窄型;间接征象为肝内及肝外胆管扩张、肝内及肝门部淋巴结转移和腹水。误诊3例,其中1例为胆总管结石,2例为十二指肠憩室。结论超声显像对肝外胆管癌的诊断有重要价值。     

Preliminary experience using endoscopic ultrasonography in the diagnosis of choledocholithiasis.

Twenty patients with symptomatic cholelithiasis and suspected choledocholithiasis were evaluated in an ongoing prospective trial using endoscopic ultrasonography (EUS), standard abdominal ultrasonography (US) and ERCP for the detection of choledocholithiasis prior to laparoscopic cholecystectomy. EUS was used successfully to image the extrahepatic bile duct in all patients. EUS detected three of four proven bile duct stones and correctly identified 16 bile ducts as stone free, thus being more accurate than standard abdominal US. The preliminary results of this ongoing prospective trial and the experience reported by other authors suggest that EUS may be as sensitive as ERCP in the detection of choledocholithiasis.     

超声内镜在胃淋巴瘤诊断中的应用

目的：探讨超声内镜（EUS）对原发性胃淋巴瘤的诊断价值。方法：对12例胃淋巴瘤患者行EUS检查，与胃镜及活检、胃肠钡餐及手术后病理进行对照研究。结果：12例胃淋巴瘤中EUS诊断符合率83．33％，显著高于胃镜（58．33％）（P＜0．05）及胃肠钡餐（16．67％）（P＜0．05）。EUS对胃淋巴瘤T、N分期的诊断准确性分别为100％、77．78％。结论：EUS诊断胃淋巴瘤的符合率高于胃镜及其它检查，并能准确判断胃淋巴瘤浸润胃壁深度、侵犯周围器官及淋巴结情况。     

胰腺癌的超声内镜诊断

本文报告超声内镜（ＥＵＳ）对５０例胰腺癌的诊断正确率、图像特征及术前进展程度诊断的研究。结果表明：①ＥＵＳ对胰腺癌的显示率达１００％，诊断正确率达９４％，高于ＵＳ、ＣＴ和ＥＲＣＰ。②胰腺癌局限性肿大占９２％，边缘隆起占８０％，高回声占８％，混合回声１２％。６２％的胰腺癌有胰管扩张，６４％有胆管扩张，５６％有淋巴结转移。③ＥＵＳ对胰腺癌术前被膜浸润、胰后方组织浸润、淋巴结转移和门脉浸润的诊断正确率分别为７２％、７４％、７６％和８０％。     

36例胰头癌超声内镜诊断分析

目的 总结分析胰头癌的超声内镜的影像学表现与诊断。方法 回顾性分析36例胰头癌的超声内镜、体外B超、螺旋CT的影像学表现、肿瘤学标记物测定，总结其特点。结果 超声内镜下胰头癌主要表现为边界不清晰（22／32）的低回声（21／32），伴有胆总管和胰管的扩张（19／36）、血管的侵犯（26／32）；EUS检查的诊断正确率为65．6％（21／32），判断肿瘤的血管浸润及淋巴结转移准确率均为81．3％（26／32）；体外B超三者的准确率分别为43、8％（14／32）、43．8％（14／32）、563％（18／32）；螺旋CT三者的准确率分别为59．4％（19／32）、81．3％（26／32）、68．8％（22／32）。患者CA19-9测定显著升高，CA125和CEA大多正常。结论 超声内镜准确判断胰头癌仍需进一步积累经验；本组资料中，螺旋CT的诊断准确率、判断淋巴结转移及周围血管侵犯准确率与EUS比较无明显优越性。EUS与螺旋CT结合，对胰头癌的术前诊断和可切除性判断具重要价值。     

原发性进展期胆囊癌的超声诊断及其判断转移性的价值

目的:探讨进展期胆囊癌的超声声像图特征及判断其转移性对临床治疗的价值。方法:对经手术及病理证实的39例进展期胆囊癌的手术记录及超声声像图进行回顾性对比分析。结果:超声声像图分为囊壁增厚型、蕈伞型、混合型、实块型,同时能观察到肝内转移、肝浸润、区域淋巴结转移及胆囊结石、肝内外胆管扩张等征象。结论:进展期胆囊癌的正确诊断及判断其转移性情况对临床手术治疗有重要价值。     

经食道超声探测食管癌局部淋巴结及临床意义

本文总结了８１例中晚期食管瘤纵隔局部淋巴的食道超声检查结果。ＴＵＳ局部淋巴结显示率约４１．０％。ＴＵＳ图像上食管旁淋巴结多呈圆形或类圆形的较均匀的低回声区，边界清晰。切面直径＞１０．０ｍｍ的淋巴结或直径５．０～１０．０ｍｍ但Ｓ／Ｌ＞０．５的淋巴结应提示有癌转移。多数转移淋巴结的边界清晰、锐利。癌肿旁淋巴结相互粘连，结聚或与肿瘤融合常是淋巴结转移的直接征象。ＴＵＳ判断局部淋巴有无转移的准确率为７７．２％，这有助于临床上食管癌的术前ＴＮＭ分期。     

Laparoscopic ultrasound (LUS) in gastrointestinal surgery.

Intraoperative ultrasonography during abdominal surgery became widespread by availability of high-frequency, high-resolution transducers. It's usefulness has particularly been proven in biliar and gastrointestinal surgery. Our objective was to examine the method in laparoscopic cholecystectomy and in laparoscopic staging of malignancies of the upper gastrointestinal tract as well. Lapaoscopic ultrasound (LUS) examination was performed in 567 patients operated on because of biliary stones and in 12 patients with carcinoma in the upper part of the gastrointestinal tract. In accordance to the known criteria endoscopic retrograde cholangiopancreatography (ERCP) was performed in 89 patients, and additionally, ERCP was performed in 58 patients because of dilated common bile duct. Choledochal stones were demonstrated in 72 of the 147 patients. Laparoscopic ultrasonography demonstrated preoperatively undetected bile duct stones in 18 of these patients (12%). In 294 other patients without any criteria of bile duct stones, laparoscopic ultrasonography demonstrated bile duct stones in 11 patients (4%). Laparoscopic ultrasonography in 12 patients with proximal gastrointestinal malignancies demonstrated inoperability in all of the patients. Laparotomy could thereby be avoided. LUS examination is an ideal operative tool as it is safe, reproducible and requires no special patient preparation or positioning. The method of imaging is therefore justified for patients undergoing laparoscopic surgery because of biliary stones and gastrointestinal surgery.     

Follow-up of selective endoscopic ultrasonography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy: a prospective study of 300 patients

BACKGROUND AND STUDY AIMS: This prospective study evaluated the selective use of endoscopic retrograde cholangiography (ERC) and endoscopic ultrasonography (EUS) in the context of laparoscopic cholecystectomy (LC). PATIENTS AND METHODS: Between 1993 and 1998, LC for symptomatic gallstones was indicated in 300 consecutive patients. In order to diagnose and treat choledocholithiasis preoperatively, we performed, on the basis of preoperative criteria, ERC in "high-risk" patients and EUS in "intermediate-risk" patients. Choledocholithiasis was treated by preoperative biliary endoscopic sphincterotomy (BES). LC was performed either after the endoscopic procedure or directly in "low-risk" patients. RESULTS: A total of 104 patients (35%) had 118 preoperative procedures: a) EUS (n = 68; feasibility 100%): choledocholithiasis was observed in 14/68 patients (21%); b) ERC (n = 50; feasibility 94%): 36 ERC were indicated on on preoperative criteria, and 14 on the basis of EUS results. Choledocholithiasis was found in 41/ 50 patients (82%) (13/14 patients with positive EUS), 19% of "intermediate-risk" patients, and 78% of "high-risk" patients; ERC failed in three patients who had no choledocholithiasis on subsequent intraoperative cholangiography (IOC). Clearance of the common bile duct (CBD) was achieved after BES in 41/41 patients. There was no mortality; complications occurred in 4/ 300 patients (1%). No retained stones were found in patients of any of the three groups, after a mean follow-up of 32 months. CONCLUSIONS: Combined endoscopic and laparoscopie management of cholecystolithiasis and choledocholithiasis is a viable option and is optimized by the use of EUS.