正常小肠的腔内超声影像及小肠超声内镜的临床应用

Intra-luminal Ultrasonic Image of the Normal Small Intestine and Clinical Application of Intra-small Intestinal Ultrasonography

目的体外研究正常小肠的腔内超声影像及初步评估小肠腔内超声内镜的临床应用价值及其可行性和安全性。方法2004年8月～2006年6月,13例不明原因的消化道出血、慢性腹泻、腹痛疑为小肠疾病的患者纳入研究。在双气囊小肠镜(DBE)检查中发现病灶或病变肠段后,经活检孔道插入超声小探头行小肠腔内超声(ISUS)探查;此外,对外科手术切除标本的部分正常空、回肠行体外模拟腔内超声探查。结果13例患者均成功行DBE检查,11例发现阳性病灶或病变肠段,其中10人完成ISUS检查。ISUS探查结果提示恶性肿瘤2例、小肠间质瘤3例、淋巴管瘤1例、息肉1例、早期Crohn病2例,1例经DBE发现为小肠毛细血管扩张症患者未能经ISUS获得确切影像,1例ISUS探查失败。研究发现,ISUS的诊断准确性为81.8%(9/11),但与DBE相结合时其准确性可达100%(11/11)。此外,通过对空、回肠的体外超声探查,显示小肠肠壁可被分成包括绒毛层在内的6层结构。结论ISUS是一种在DBE基础上临床安全、可行的用于小肠疾病诊断的辅助手段,尤其对小肠黏膜下肿瘤的鉴别、癌肿的分期以及早期CD的诊断具有较好的临床价值。同时,本研究还提出了正常小肠壁腔内超声影像6个层次的分层观点。

Objective： The aim of tiffs in vitro and in vivo study is to understand the intra-luminal uin-asonic image of the normal small intestine and to evaluate the clinic value and the feasibility of the intra-small intestinal ultrasonography （ ISUS ） for small-intestinal diseases. Methods： From June 2004 to June 2006, 13 patients （ 9 males, 4 females, mean age 56 years old ） with chronic diarrhea, obsure GI bleeding and unknown abdominal pain were enrolled into the research.All the patients underwent double-balloon enteroscopy （ DBE ）. First and intra-small intestinal ultrasonography was perform in the DBE positive patients by advancing the prototype probe through the accessory channel of enteroscope. Meanwhile, we defined normal intraluminal image of the jejunum and ileum by in vitro study. Results： Of the 13 patients, 11 had positive lesions diagnosed by DBE, and ISUS was successfully completed in 10 subjects. ISUS revealed 2 cases of neoplasms, 3 cases of GIST, 1 case of lymphangioma, 1 case of polyp and 2 cases of early acute stage Crohn＇s disease. However, the ISUS image was not clear enough to detect mucosal vascular deformities. The ISUS assessments were in accordance with surgical interventions and histological biopsy results with a diagnostic accuracy of 81.8% （ 9/11 ） while it was 100% in combined with DBE. By in vitro study, we found there were six layer imaging structures of the normal small intestine which correlated with histology. Condusions： The present preliminary study indicated that ISUS is a safe, fessible and effective adjunctive modality on diagnosis of small-intestinal diseases. Also, our study firstly difined the normal anatomy of small-intestine as six imaging layers.