内镜超声对胃肠道脂肪瘤的诊治价值

目的评价内镜超声（EUS）诊断胃肠道脂肪瘤的价值及其对治疗的指导意义。方法回顾135例EUS诊断为胃肠道脂肪瘤患者的临床资料，观察胃肠道脂肪瘤的EUS图像特征，与病理结果进行对照。结果脂肪瘤EUS表现为起源于黏膜下层（极少数为浆膜下）的高回声或偏高回声包块，内部回声均匀，边界清晰，部分伴后方回声衰减。40例接受治疗（内镜治疗25例，包括尼龙套套扎9例、圈套高频电切5例、ESD切除11例，手术切除15例），其中38例病理证实为脂肪瘤，EUS诊断与病理结果符合率为95．00％（38／40）；病理证实34例脂肪瘤位于黏膜下层（其中1例累及肌层，1例累及浆膜），2例位于肌壁间，2例位于浆膜下，EUS判断脂肪瘤起源与病理结果的符合率为94．74％（36／38）。结论EUS能够明确脂肪瘤的起源、大小、形态、内部回声及边界，并可指导选择治疗方案。

Endoscopic ultrasonography in diagnosis and therapy of gastrointestinal lipoma

Objective To observe the value of endoscopic ultrasonography (EUS) in diagnosis and treatment of gastrointestinal lipoma. Methods A total of 135 patients with gastrointestinal lipoma diagnosed by EUS were retrospectively analyzed, and the endosonographic features were observed. EUS results of 40 patients were compared with pathological results after endoscopic treatment or surgery resection. Results The lipomas presented as submucosal (only a small proportion as subserous) hyperechoic masses with homogenous echo and distinct border and some with ultrasonic attenuation. Among 40 patients receiving treatment, 25 underwent endoscopic resection, including 9 by endoloop, 5 by snare high-frequency electroresection and 11 by endoscopic submucosal dissection (ESD), the other 15 cases were treated by operation. Thirty eight were diagnosed pathologically as gastrointestinal lipoma, and the diagnostic accuracy of EUS was 95.00% (38/40). Pathologic study showed that 34 tumors originated from submucosa with 1 involved muscular and 1 involved serosa, 2 originated from intramural, and 2 from subserous. The accuracy of EUS for the origin of lipoma was 94.74% (36/38). Conclusion EUS can provide definite information of gastrointestinal lipoma about its originating layer, size, form, internal echo and border, which can guide the treatment options.