内镜超声在非胰岛素瘤胃肠胰腺神经内分泌肿瘤定位诊断中的作用

背景：准确的定位诊断是胃肠胰腺神经内分泌肿瘤（GEP-NETs）患者手术成败的关键。内镜超声（EUS）可在近距离内对胃肠壁、胰腺及其毗邻结构行超声检查。目的：评价EUS在非胰岛素瘤GEP-NETs定位诊断中的作用。方法：对1996年6月～2007年6月北京协和医院诊断的非胰岛素瘤GEP-NETs患者进行回顾性分析，总结其EUS表现．并与其他影像学检查方法的敏感性进行比较。结果：共纳入11例非胰岛素瘤GEP-NETs患者，检出原发病灶16个，EUS的敏感性为75．0％（12／16）。如剔除一例因有胃大部切除史而干扰检查者，EUS的敏感性可达90．9％（10/11）。腹部CT平扫＋增强、腹部B超、生长抑素受体显像和血管造影的敏感性分别为56．2％（9／16）、37．5％（6，16）、66．7％（8／12）和57．1％（4／7）。EUS显示的12个病灶中，低回声者8个（66．7％），回声不均匀者7个（58．3％），边界清晰者11个（91．7％）。EUS显示的最小病灶直径为0．5cm。结论：EUS对非胰岛素瘤GEP-NETs的定位诊断具有较高敏感性．优于腹部CT、腹部B超、生长抑素受体显像等传统定位方法。

Localization of Non-insulinoma Gastroenteropancreatic Neuroendocrine Tumors by Endoscopic Ultrasonography

Background： Accurate preoperative localization is the key point of the treatment of gastroenteropancreatic neuroendocrine tumors （GEP-NETs）. Endoscopic ultrasonography （EUS） is a diagnostic technique for detecting abnormalities in gastroenteric walls, pancreas and adjacent structures. Ainu： To investigate the role of EUS in the localization of non-insulinoma GEP-NETs. Methods： Patients with non-insulinoma GEP-NETs diagnosed in Peking Union Medical College Hospital from June 1996 to June 2007 were reviewed retrospectively. The endoscopic ultrasonic patterns were summarized, and the sensitivity of EUS was calculated and compared with that of other imaging techniques. Results： Eleven non-insulinoma GEP-NETs patients were enrolled and altogether 16 primary tumors were detected. The sensitivity of EUS was 75.0% （12/16）. Eliminating one patient with a history of subtotal gastrectomy which obviously changed the local anatomic structures, the sensitivity of EUS was 90.9% （10/11）. The sensitivities of abdominal CT, abdominal ultrasonography, OctreoScan and angiographywere56.2% （9/16）, 37.5% （6/16）, 66.7% （8/12） and57.1% （4/7）, respectively. As to the endoscopic ultrasonic patterns, of the 12 tumors identified by EUS, 8 （66.7%） were hypoechogenic, 7 （58.3%） were inhomogeneous in echo, and 11 （91.7%） were well delimited. The smallest tumor detected by EUS was 0.5 cm in diameter. Conclusions： EUS is a sensitive technique for the localization of non-insulinoma GEP-NETs, and is superior to traditional imaging methods, including abdominal CT, abdominal ultrasonography and OctreoScan, etc.