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。

EUS for diagnosis of 9 esophageal tuberculosis patients: analysis and literature review

Objective?To improve diagnosis on esophageal tuberculosis by the endoscopic ultrasonography (EUS).?Methods?A retrospective analysis of 9 cases of esophageal tuberculosis patients diagnosed by EUS or EUS guided fine needle aspiration (EUS-FNA) who were treated from 2011 to 2016 and literature reviewed.?Results?The main presenting symptoms were dysphagia (6 cases), burning pain after sternum (3 cases), low-grade fever and night sweat (2 cases), cough and hemoptysis (1 case). The middle esophagus was involved in 7 cases, upper and lower third of the esophagus were affected in 1 cases. The endoscopic appearances included ulcer (1 case), mass lesion (8 cases). The diagnoses were confirmed by biopsies with pathology in 5 cases. The layers of the esophageal wall were unclear or disappeared in some cases, and in some patients low echo occupying lesions inside or outside the esophageal wall were showed by EUS. The internal echo of the lesions was heterogeneous, and strong echo spots could be observed. In most cases, enlarged mediastinal lymph nodes were observed. EUS-FNA was used to take biopsy specimens in 2 cases: biopsy specimens suggested tuberculosis; and anti-TB treatment has good effect as well.?Conclusion?Dysphagia is the major clinical symptom of esophageal tuberculosis, always influences the middle part of the esophagus. The commonest abnormalities identified by endoscopy are ulceration and mass lesion. The diagnostic rate of the disease can be improved by endoscopic examination with biopsies, EUS and EUSFNA data.