小肠腔内超声在小肠疾病诊断中的初步临床研究

Preliminary study of intra-small intestinal ultrasonography in the diagnosis of small intestinal diseases

目的评估小肠腔内超声(ISIU)检查对小肠疾病诊断的价值及可行性和安全性。方法对2004年6月至2005年2月间11例因不明原因慢性腹泻、隐性出血及腹痛怀疑小肠疾病的患者行双气囊小肠镜(DBE)检查,发现局部病灶或病变肠段后,经DBE活检孔道插入特制超声小探头进行 ISIU探查,取得正常肠壁以及局部病灶或病变肠段ISIU影像图并对其进行分析。结果 11例患者中, DBE发现阳性病灶并行ISIU检查9例,其中成功完成ISIU探查者8例,平均用时20 min。提示侵犯浆膜层的恶性肿瘤2例(术后病理证实),表现为小肠绒毛层消失,其余小肠壁层次破坏,代之以不均低回声区域;小肠间质瘤1例(起源于肌层,术后病理证实),表现为边界清晰的均匀低回声区域内伴有部分高回声;肠壁黏膜层来源息肉1例(活检证实),影像特征为均匀高回声区域;早期克罗恩病2例,表现为小肠绒毛层消失,其余肠壁层次模糊伴全层小肠壁增厚;淋巴管瘤1例,表现为内伴管样结构的均匀中低回声区域;对于DBE发现的小肠毛细血管扩张症患者,ISIU影像不能明确诊断。另有1例DBE发现增殖性病灶的患者,由于病灶位置较深,位于空回肠交界部,经口DBE中超声小探头不能经由内镜活检孔道送出导致探查失败。所有ISIU探查均未发现相关的并发症。结论 ISIU是一种安全有效的辅助检查手段,尤其对小肠黏膜下肿瘤的性质鉴别、早期克罗恩病的诊断及肿瘤侵犯深度的判断存在明显优势。

Objectives To evaluate clinical value and feasibility of intra-small intestinal ultrasonography （ISIU） in the diagnosis of small-intestinal diseases. Methods From June 2004 to February 2005, 11 patients with obscure gastrointestinal bleeding, chronic diarrhea or unknown abdominal pain were enrolled. All patients who suspected with small intestinal diseases underwent initial double-balloon enteroscopy （DBE）. ISIU were performed in all DBE positive patients to determine the abnormality of echo characteristics of the lesions. Ultrasonic system SP-702 （Fujinon） and prototype miniature probe （Fujinon） were used. Results Of 11 patients, 9 positive lesions were macroscopically diagnosed by DBE, ISIU were successfully completed in 8 cases within 20 minutes on average for each procedure. ISIU revealed 2 cases of small intestinal carcinoma presenting with heterogeneous hypoechoic area with disappearance of intestinal villus layer, 1 case of gastrointestinal stromal tumor originated from muscularis propria characterized by homogeneous hypoechoic area with hyperechoic loci, 1 case of polyp originated from mucosa layer presenting with homogeneous hyperechoic area, 1 case of lymph-vessel tumor characterized by homogeneous hypoechoic area with tubular structure in the lesion, 2 cases of early acute stage Crohn＇s disease characterized by disappearance of intestinal villus layer with whole wall thickening. The intra-luminal ultrasonic image was not clear enough to detect mucosal vascular deformity. One case was failed to detect because the location of the neoplasm was in the conjunctional part of jejunum and ileum, the miniature probe can not be pushed out of accessory channel of DBE. The imaging diagnosis of proliferated neoplasms was in accordance with surgical interventions and histological results. Conclusions ISIU is an effective and safe procedure for assistant diagnosis of small intestinal diseases, especially helps to define submucosal tumors, Crohn＇s disease and tumor invasion. The successful rate and accuracy of the diagnosis depends on the location of the lesion and experiences of the endoscopists.