消化系统疾病

20030985微探头超声对下消化道疾病的诊断价值/周平红…刀中华消化内镜杂志一2002,19(4)一205~207 用微探头超声对115例下消化道病灶进行内镜超声检查(EUS)。结果:结直肠癌81例,EUS下表现为低回声肿块,对肿瘤侵犯深度诊断总准确率为82.7%(67/81),肠壁周围淋巴结转移的敏感性55.4%(36/65),特异性68.8%(11/a6);粘膜下肿瘤15例,除1例平滑肌瘤误诊为平滑肌肉瘤外,其余病例均得到正确诊断;溃疡性结肠炎10例;克罗恩氏病9例。认为微探头超声对结直肠癌侵犯深度和粘膜下肿瘤的诊断有很高准确率,术前检查可为结直肠癌和粘膜下肿瘤选择合适的治疗方…     

超声微探头在结直肠癌术前诊断中的价值

目的探讨超声微探头在结肠癌术前诊断中的价值。方法回顾性分析30例结肠癌患者的超声微探头检查结果，并与术后病理对照。结果超声微探头检查显示：结肠癌T1期7例；T2期5例，T3期17例，T4期5例；与术后病理结果对照，肿瘤的T分期诊断准确率为80．0％（24／30），N分期准确率为73．3％（22／30），其中6例癌性狭窄患者T分期准确率为83．3％（5／6），N分期准确性率66．7％（4／6），8例患者根据术前超声微探头检查结果修订的治疗方案最终证实是合理的。结论在结肠镜操作过程中一次完成的微探头超声检查提高了结直肠癌和癌性狭窄病变术前分期的准确性，在结直肠癌治疗方案制订中具有独特价值。     

小探头超声（MPS）检查在消化道疾病临床应用的初步探讨

目的传统内镜尚难对消化道粘膜隆起病灶的性质以及肿瘤浸润深度作出判断。本文旨在评估小探头超声（ＭＰＳ）检查在此方面的应用价值。方法对６０例（手术患者３９例）常规内镜检查发现病灶的患者，于内镜检查的同时行ＭＰＳ检查，其结果与常规内镜下的肉眼诊断、病理活检以及手术后病理结果作对比。结果对粘膜隆起病灶且内镜下病理活检阴性的患者，与手术发现比较。ＭＰＳ的诊断准确率为９０．５％（１９／２１）；而对于消化道肿瘤的浸润深度，ＭＰＳ的判断均与手术后结果相符１００％（２３／２３）。结论对消化道粘膜隆起病灶的性质鉴别，ＭＰＳ显著优于常规内镜及病理活检，具有一定临床诊断价值；对消化道肿瘤，ＭＰＳ仅对肿瘤浸润消化道壁的深度能作出准确判断，而对周围淋巴结累及与邻近脏器转移的诊断仍有其局限性。     

小探头超声内镜在上消化道粘膜下肿瘤诊断和治疗中的应用

目的探讨小探头超声内镜在上消化道枯腹下肿瘤诊断和治疗中价值。方法对117例常规内镜诊断为上消化道粘膜下肿瘤的病人，行小探头超声内镜险查，部分小探头超声内镜后行内镜下电切、氩气刀、手术切除等，并分析相关结果。结果117例常规内镜诊断为上消化道粘膜下肿瘤的病人行小探头超声检查诊断为壁外压迫22例（占18．8%），95例为消化管壁病变，其中平滑肌瘤58例（占61．1%），平滑肌肉瘤4例（占4．2％），脂肪瘤5例（占5．3％），异位胰腺6例（占6．3％），息肉12例（占12.6％），粗大粘膜皱襞4例（占4.2%），管壁囊肿3例（占3.2%），孤立静脉瘤3例（占3．2％）。其中32例经过高频电切、手术取得足够病理标本者，病检结果平滑肌瘤12例、平滑肌肉瘤4例、异位胰腺4例、息肉12例。结论小探头超声内镜能准确显示消化道各层结构，对判断壁外压迫和粘膜下肿瘤的起源、大小、性质具有很大的价值。EUS是粘膜下肿瘤进一步治疗方法选择的首批方法．但在判断肿瘤的良恶性仍有一定的局限性。     

内镜超声对胰腺癌的诊断

目的 探讨内镜超声（EUS）检查对胰腺癌的诊断价值。方法 对116例胰腺癌患者行EUS检查，其中16例经管内超声（IDUS）检查并与体表B超（B超），CT，磁共振成像（MRI），内镜逆行胰胆管造影（ERCP）检查结果进行比较。结果 EUS（IDUS)诊断胰腺癌的敏感性与准确性均明显高于B超，与CT，MRI及ERCP相当，EUS诊断准确率为98．2％（114／116），IDUS为100％（16／16）；CT为85．3％（99／116）；MRI为87．0％（54／62）；ERCP为80．6％（79／98）；B超为73．2％（85／116）。结论 EUS对胰腺癌有较大的诊断价值。     

经内镜微超声探头对食管疾病的诊断价值

为探讨经内镜微超声探头（ＴＥＭＰ）对食管病变的诊断价值，对食管粘膜下肿瘤、食管癌、贲门失驰缓症、食管炎、食管息肉及静脉曲张等５３例病变进行微探头超声检查。结果：ＴＥＭＰ检查能正确反映粘膜下肿瘤起源、癌肿侵犯深度，鉴别食管疾病的良恶性，判断硬化剂治疗食管静脉曲张的疗效；改变病人的体位，对检查不部位病灶有助。结果说明ＴＥＭＰ检查对食管病变诊断与鉴别有较大的价值。     

内镜超声检查术对胰腺肿瘤早期诊断的价值

目的探讨内镜超声检查术（EUS）、管内超声检查术（IDUS）及超声内镜引导下细针穿刺术（EUS-FNA）对胰腺肿瘤早期诊断的价值。方法回顾性分析和比较188例胰腺小占位病灶的EUS、IDUS、EUS—FNA及其他影像学检查结果。结果（1）EUS诊断小胰腺癌的准确率是95．6％（44／46）,优于B超58．6％（27／46）、CT77．4％（24／31）、MRI76．2％（16／21）及内镜逆行胰胆管造影术（ERCP）85．3％（29／34）。小胰腺癌EUS声像图主要表现为类圆形、边界清楚、边缘不规则的低回声肿块,内部回声多均匀。（2）25例胰腺小占位病灶行IDUS检查,其准确率是100．0％（25／25）,明显优于B超32．0％（8／25）、CT52．9％（9／17）及MRI57．9％（11／19）等检查。（3）18例胰腺小占位病灶行EUS—FNA,其准确率是66．7％（12／18）。（4）EUS诊断胰腺假性囊肿的准确率是100．0％（27／27）,明显优于13超52．0％（13／25）、CT66、7％（12／18）、MRI82．4％（14／17）及ERCP78．9％（15／19）;对胰腺囊性肿瘤分类鉴别诊断总的准确率是57．7％（15／26）,优于B超19．2％（5／26）、CT36．4％（8／22）、MRI37．5％（6／16）及ERCP50．0％（7／14）等检查。结论EUS、IDUS及EUS-FNA对胰腺肿瘤的早期诊断具有重要价值。     

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。     

超声小探头对结直肠癌术前分期诊断的初步研究

目的：超声小探头（ultrasonic miniprobe,UMP）应用于结、直肠癌术前分期的准确性及可行性。方法：对50例结、直肠癌患者做UMP检查,对准病灶进行全瘤扫描,择最佳影像冻结、摄片,退出UMP,最后做活组织检查,全部病例均行根治术,癌周淋巴结分组编号、装瓶、送病理检查。结果：本组UMP对50例结、直肠浸润深度（T分期）与术后病理浸润深度对比,其准确率T1－T4期分别为75％,80％,88％及67％,T分期的总准确率为84％（P＜0．01）,过高分期5例（10％）,过低分期3例（6％）;N分期,UMP诊断阳性淋巴结（n=22),术后病理（n=28),准确率795,UMP诊断阴性淋巴结（n＝20）,术后病理（n＝22）,准确率91％,总准确率84％（42／50）,敏感性79％,特异性为91％（P＜0．01）。结论：（1）UMP是当前应用于结、直肠癌术前TNM分期最有实用价值的方法之一。肿瘤狭窄患者适应术前分期检查。（2）UMP系高频超声频探头,由于超声穿透深度的限制。对远处转移的M分期是不可能的。（3）UMP对浸润深度及处淋巴结转移有一定的参考价值。并应结合其它影像检查如腹部B超、CT等,扬长弃短,相辅相成,以提高术前分期的准确性及完整性。     

CT仿真内窥镜与超声造影对结直肠癌的诊断价值

目的评价CT仿真内窥镜（CTVE）和超声造影（CEUS）在结直肠癌诊断中的价值。方法对30例结直肠癌患者术前进行CTVE和CEUS检查，将二者结果与手术后的病理结果对比。结果CTVE对结直肠癌的诊断准确率96．67％（29／30），CEUS对结直肠癌的诊断准确率为90％（27／30）。结论CTVE和CEUS可以准确显示结直肠癌病灶，有助于结直肠癌的准确诊断。     

Accuracy of high‐frequency catheter‐based endoscopic ultrasonography according to the indications for endoscopic treatment of early gastric cancer

Background and Aim: The development of endoscopic treatment, such as endoscopic submucosal dissection, extends the indications for endoscopic resection in patients with early gastric cancer (EGC). Endoscopic ultrasonography (EUS) is the first‐choice imaging modality for determining the depth of invasion of gastric cancer. The aim of the present study was to prospectively assess the accuracy of EUS for determining the depth of EGC, according to the accepted/extended indications. Methods: We prospectively included a total of 181 lesions in 178 patients, with an endoscopic diagnosis of EGC, who underwent EUS for staging the depth of tumor invasion using a 20‐MHz catheter probe. We investigated the accuracy of EUS for determining the depth of endoscopically‐suspected EGC and then analyzed the difference in the accuracy of EUS according to the accepted/extended indications. Results: Of the 178 patients, five patients were dropped because of the absence of final histological results. For the 176 lesions in 173 patients, the accuracy of EUS assessment for the depth of tumor invasion was 80.7% (142 of 176 lesions). The accuracy of EUS for the lesions with accepted indications and with extended indications was 97.6% (40 of 41 lesions) and 83.6% (46 of 57 lesions), respectively (P = 0.040). Of the lesions with extended indications, the accuracy of EUS decreased especially for the lesions with ulceration and those with minute submucosal invasion (79.2% and 42.9%, respectively). Conclusions: The accuracy of EUS for the lesions with the extended indications was lower than that for the lesions with the accepted indications. In particular, lesions with ulceration and minute submucosal invasion should be carefully considered prior to endoscopic treatment by pretreatment EUS staging.     

内镜超声在结直肠黏膜下隆起性病变的应用分析

目的探讨超声内镜检查术（endoscopic ultrasonography,EUS）在结直肠黏膜下隆起性病变的应用价值,为临床诊疗策略提供依据。方法回顾性分析2015年10月—2019年10月天津市人民医院电子结肠镜检查发现并经EUS及手术切除后病理学确诊的229例结直肠黏膜下隆起性病变患者资料,分析病变的位置分布、种类、EUS特征及EUS初步诊断与病理诊断符合情况。结果病变部位以直肠[44.98%(103/229）]、升结肠[15.28%(35/229）]常见。病理结果显示病变以脂肪瘤最常见[34.93%（80/229）],部位以横结肠[22.50%（18/80）]、升结肠[20.00%（16/80）]为主;其次为神经内分泌瘤[33.63%（77/229）],部位以直肠[96.10%（74/77）]为主;再次为囊肿[18.78%（43/229）]。EUS下229例病变起源于黏膜下层215例,黏膜肌层11例,固有肌层3例。EUS诊断与病理结果整体诊断符合率为89.08%（204/229）,EUS诊断符合率脂肪瘤为100.00%（80/80）、气囊肿为5/5、间质瘤为3/3、神经内分泌瘤为81.82%（72/88）、囊肿为89.13%（41/46）、平滑肌瘤为1/4、淋巴管瘤为2/5,颗粒细胞瘤、神经纤维瘤均为0。结论EUS对结直肠黏膜下病变的起源层次、回声特点及病变性质等具有较准确的诊断,但对颗粒细胞瘤及神经纤维瘤等少见肿瘤的诊断具有一定局限性。     

卢戈液-美蓝双重染色在早期食管癌诊断中的价值

目的 提高早期食管癌的诊断水平。方法 先用卢戈液染色，再用美蓝染色，比较2次染色后食管病灶着色及范围，大致判断浸润深度，并用超声小探头观察病灶侵犯深度，采用内镜下黏膜切除术和手术治疗。结果 10例患者共11处癌灶，卢戈液染色后9处较好地显示了病灶范围，表现为正常食管黏膜染为棕色，病灶不着色；加用美蓝染色后，11处均清楚地显示了病灶，表现为正常黏膜不染色，病灶黏膜为水蓝色，边界清晰。1例行内镜下食管黏膜切除术切除，8例手术切除。病理结果均为鳞状细胞癌，其中黏膜癌6处，黏膜下癌4处，与其对照，胃镜和超声小探头鉴别黏膜癌和黏膜下癌的准确率均为80％，两者联合的准确率为90％。结论 卢戈液-美蓝染色较单一卢戈液染色，显示早期食管癌病灶及其范围更加清楚，可较准确地判断早期癌的侵犯深度。     

Clinical usefulness of endoscopic ultrasonography for the evaluation of ulcerative colitis-associated tumors

AIM:To evaluate the clinical usefulness of endoscopic ultrasonography(EUS) for the diagnosis of the invasion depth of ulcerative colitis-associated tumors.METHODS:The study group comprised 13 patients with 16 ulcerative colitis(UC)-associated tumors for which the depth of invasion was preoperatively estimated by EUS.The lesions were then resected endoscopically or by surgical colectomy and were examined histopathologically.The mean age of the subjects was 48.2 ± 17.1 years,and the mean duration of UC was 15.8 ± 8.3 years.Two lesions were treated by endoscopic resection and the other 14 lesions by surgical colectomy.The depth of invasion of UCassociated tumors was estimated by EUS using an ultrasonic probe and was evaluated on the basis of the deepest layer with narrowing or rupture of the colonic wall.RESULTS:The diagnosis of UC-associated tumors by EUS was carcinoma for 13 lesions and dysplasia for 3 lesions.The invasion depth of the carcinomas was intramucosal for 8 lesions,submucosal for 2,the muscularis propria for 2,and subserosal for 1.Eleven(69%) of the 16 lesions arose in the rectum.The macroscopic appearance was the laterally spreading tumor-non-granular type for 4 lesions,sessile type for 4,laterally spreading tumor-granular type for 3,semipedunculated type(Isp) for 2,type 1 for 2,and type 3 for 1.The depth of invasion was correctly estimated by EUS for 15 lesions(94%) but was misdiagnosed as intramucosal for 1 carcinoma with high-grade submucosal invasion.The 2 lesions treated by endoscopic resection were intramucosal carcinoma and dysplasia,and both were diagnosed as intramucosal lesions by EUS.CONCLUSION:EUS provides a good estimation of the invasion depth of UC-associated tumors and may thus facilitate the selection of treatment.     

Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study

BACKGROUND: Endoscopic ultrasonography (EUS) is commonly agreed to be the best imaging method for diagnosing and differentiating between submucosal lesions in the gastrointestinal tract. However, most of the current evidence for this derives from retrospective multicenter studies. A prospective multicenter analysis of the performance of EUS in diagnosing submucosal lesions in everyday practice was therefore conducted. METHODS: Over a 2-year period, this study included 150 patients (52% men, mean age 59.8 years) from 23 centers who had a presumptive diagnosis of a submucosal lesion on upper gastrointestinal endoscopy. The patients' symptoms and EUS results were recorded. Endoscopic and endosonographic findings regarding lesion size, layer of origin, and the presumptive diagnosis (benign or malignant) were recorded. The reference methods used were surgery, biopsy, other imaging tests, and a follow-up period of 6 months. RESULTS: Of the 150 patients, 102 had an intramural lesion (84 tumors, 18 other lesions such as cysts, aberrant pancreas, etc.), and 48 had an extraluminal compression--in most cases (n = 35) by normal organs or structures. For differentiating between a submucosal and an extraluminal compression, the sensitivity and specificity of endoscopy were 87% and 29%, whereas those of EUS were 92% and 100%. However, the sensitivity and specificity of EUS for differentiating between malignant and benign submucosal tumors were only 64% and 80%, respectively. CONCLUSIONS: The accuracy of EUS in differentiating between submucosal tumors and extraluminal compressions is substantially superior to that of endoscopy, but EUS is still inadequate for differential diagnosis between benign and malignant submucosal tumors. However, EUS is still the best method of visualizing submucosal lesions precisely. The influence of EUS on the further management in these patients remains to be examined in subsequent studies.     

内镜超声诊断胃肠道黏膜及黏膜下隆起性病变432例

目的:探讨内镜超声(EUS)对胃肠道黏膜及黏膜下隆起性病变诊断的价值,分析胃肠道黏膜及黏膜下隆起性病变与术后临床病理诊断符合率.方法:回顾性分析胃肠道黏膜及黏膜下隆起性病变的临床资料.3100例患者术前行EUS检查,其中432例进行内镜下活检、息肉摘除术、EMR或ESD等治疗,术后将切除标本送病理.再将病理结果与术前内...     

微探头超声对上消化道间叶源性肿瘤的诊断价值探讨

目的 探讨微探头超声对上消化道间叶源性肿瘤(GIMT)的诊断价值.方法 回顾分析38例进行微探头超声检查的GIMT患者的EUS特征,并将检查结果与术后病理结果进行对照.结果 38例GIMT患者EUS诊断间质瘤25例,平滑肌瘤11例,平滑肌肉瘤2例.病理组织学及免疫组织化学检查后确诊间质瘤28例,其中中、高度恶性间质瘤6例;平滑肌瘤8例,平滑肌肉瘤1例,神经纤维瘤1例.EUS诊断准确率达89%.结论 EUS能较好鉴别GIMT与其它黏膜下肿瘤,是目前诊断黏膜下肿瘤较为准确有方法.     

Diagnosis of submucosal tumor of the upper GI tract by endoscopic resection.

BACKGROUND: Submucosal tumors are frequent findings during endoscopy, although definitive diagnosis based on histologic confirmation presents some difficulties. The aim of this study was to evaluate the efficacy and safety of endoscopic resection based on endoscopic ultrasonography (EUS) findings to reach a definitive diagnosis of submucosal tumor. METHODS: Fifty-four submucosal tumors of the upper gastrointestinal (GI) tract were included in this study. EUS was performed to determine the layer of origin and location of the lesion and to rule out malignancy. En bloc resection was attempted for lesions originating in the muscularis mucosa or submucosa. For tumors originating in the muscularis propria, we performed partial resection limited to the covering mucosa to expose the lesion and obtained a sample with standard biopsy forceps. RESULTS: Sufficient samples were obtained in all 54 cases. There was no perforation. Bleeding occurred in only 5 cases (9%) and was easily managed with endoscopic hemostatic methods. EUS and pathologic findings coincided in 74.1% of cases (40 of 54). Benign lesions (leiomyoma, aberrant pancreas, and others) were predominant (52 of 54), although 2 small lesions were confirmed at pathologic study to be malignant (leiomyosarcoma and leiomyoblastoma). CONCLUSIONS: Endoscopic resection based on EUS findings proved to be an effective and safe method to confirm the histologic diagnosis of submucosal tumor of the upper GI tract. Endoscopic resection should be considered a valuable choice for definitive management of benign submucosal tumors originating in the superficial layers.     

Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers

Endoscopic ultrasound(EUS) devices were first designed and manufactured more than 30 years ago,and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers.We review the present status,the methods,and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer.EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma.The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer,and 83%-94% for submucosal invasive cancer.But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low,making it difficult to confirm minute submucosal invasion.The accuracy of EUS using highfrequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS,although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions,undifferentiated cancer,concomitant ulceration,expanded indications,type 0-Ⅰ lesions,and lesions located in the upper-third of the stomach.A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification.Although EUS using high-frequency ultrasound probes has limitations,it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection.