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。

Application of endoscopic ultrasonography in colorectal submucosal lesions

ObjectiveTo evaluate the diagnostic value of endoscopic ultrasonography (EUS) in colorectal submucosal lesions, and provide evidence for clinical diagnosis and treatment strategies. MethodsA retrospective analysis was performed on data of 229 patients with colorectal submucosal lesions discovered by electronic colonoscopy and EUS. The diagnosis was confirmed by pathology. The location, type, EUS features of lesions and the coincidence rate of EUS and histopathological diagnosis were analyzed. ResultsColorectal submucosal lesions were common in the rectum (44.98%, 103/229) and ascending colon (15.28%, 35/229). Lipoma was the most common pathological type of colorectal submucosal lesions (34.93%, 80/229), which was commonly located in transverse colon (22.50%, 18/80) and ascending colon (20.00%, 16/80). Neuroendocrine tumor was the second one, accounting for 33.63% (77/229), and was commonly located in rectum (96.10%, 74/77), followed by cyst (18.78%, 43/229). Under EUS, 229 cases of lesions originated from submucosa in 215 cases, muscularis mucosa in 11 cases, and muscularis propria in 3 cases. The overall coincidence rate of EUS and pathological diagnosis was 89.08% (204/229). The coincidence rate of EUS diagnosis was 100.00% (80/80) for lipoma, 5/5 for air-cyst, 3/3 for intestinal stromal tumor, 81.82% (72/88) for neuroendocrine tumor, 89.13% (41/46) for cyst, 1/4 for leiomyoma, 2/5 for lymphangioma, and granulosa cell tumor and neurofibroma were both 0. ConclusionEUS has a more accurate diagnosis of the origin, echogenicity and pathological properties of colorectal submucosal lesions, but it has certain limitations for the diagnosis of rare tumors such as granulosa cell tumor and neurofibroma.