内镜超声检查在上消化道隆起性病灶诊断中的应用--附322例诊断分析

目的：探讨内镜超声检查在上消化道隆起性病灶诊断中的价值。方法：应用OLYMPUS EU-M30，GF-UM200，7.5/12MHz超声内镜对322例内镜提示上消化道隆起性病灶，部分甚至结合活检仍无法确诊进行内镜超声检查，并分析检查结果。结果：322例上消化道隆起性病灶中，以胃的隆起性病灶最多（198），其他依次为食道（95例）、十二指肠（23例）和贲门（6例）。病变性质以良性病变为主，共检出平滑肌瘤121例（位于固有肌层83例、黏膜肌层38例），其它依次为恶性肿瘤53例、外压性病变50例（其中胃底20例、脾脏外压14例）、未发现病变23例、异位胰腺20例（胃窦15例）、血管性病变16例、息肉11例、炎症9例、消化道壁增厚8例、囊肿与脂肪瘤各5例、纤维瘤1例。恶性病变及部分良性病变获组织学证实。结论：内镜超声检查能贴近病变部位进行扫描，能清楚地显示消化道壁的层次结构，对上消化道隆起性病灶具有准确的定位作用，并能较好地提示病变的性质。对明确上消化道隆起性病灶的诊断及指导治疗，具有较高的价值。但在肌瘤的良恶性判断上存在着一定困难。

The Role of Endoscopic Ultrasonography in the diagnosis of Eminence Lesions of the Upper Digestive Tract

Objective: To evaluate the Endoscopic ultrasonography (EUS) in the diagnosis of eminence lesions of upper digestive tract. Methods: The ultrasonic endoscope of OLYMPUS EU-M30, GF-UM200, 7.5/12MHzEUS was performed in 322 patients who were indicated of upper digestive tract eminence lesions by endoscopy but couldn't be diagnosed finally even combined with biopsy. Results: Many of the eminence lesions were found in the stomach (198 cases), then in esophagus (95 cases), duodenum (23cases) and cardia (6 cases). Most of the lesions are benign (83.5%) include carcinoid. There were 121 cases of leiomyoma, 53 of malignity tumor, 50 of extra-compressive lesions or organs, 23 of no positive finding, 20 of etopic pancreases, 16 of vascular lesions, 11 of polypus, 9 of inflammatory and 19 cases of others. The malignity lesions and some of the benign lesions were confirmed by pathology. Conclusion: EUS was a most valuable method in the diagnosis of eminence lesions of the upper digestive tract. It could easily detect the layered structure of the upper digestive tract wall. From the location of the lesion and the EUS image we could predict its histological nature. It could easily distinguish the lesion of the wall or the extra-compressive lesions and organs. But it was difficult to differentiate the malignant mvoeenic tumor from the benign.