284例内镜超声检查与治疗分析

Evaluation of endoscopic ultrasonography (EUS) in diagnosis and treatment of 284 patients

目的探讨内镜超声诊断与治疗价值。方法284例黏膜隆起性病变和胰腺疾病采用日本Pentax EG-3630u型超声内镜,探头频率5.0～7.5MHz,纵轴电子线阵扇扫。结果食管63例(平滑肌瘤30例,炎症6例,息肉4例,癌症6例,食管囊肿1例,外压9例),胃169例(胃炎67例、间质瘤40例、平滑肌瘤3例、癌症14例、息肉9例、脂肪瘤6例、胃溃疡2例、胃底静脉瘤2例、异位胰1例、外压25例),十二指肠16例(息肉6例,炎症1例,间质瘤3例,异位胰2例,外压1例),胰腺36例(肿瘤11例,炎症9例,假性囊肿4例,囊腺瘤1例)。治疗息肉电切治疗14例,良性肿瘤套扎治疗13例。胰腺穿刺注射治疗5例,腹腔神经丛注射治疗2例,疼痛可暂时缓解。手术病理与内镜超声诊断符合率为96.3%。结论该组黏膜隆起性病变患者中食管平滑肌瘤和胃间质瘤多见,超声图像和发生部位有助诊断。癌症、异位胰腺、脂肪瘤或脂肪肉瘤、静脉瘤、腔外压迹、扁平息肉、炎性增生等内镜超声表现特点清晰,易于诊断处理。胰腺疾病内镜超声可提高早期诊治率。

[Objective] To evaluate endoscopic ultrasonography （EUS） in the diagnosis and treatment of upper gastrointestinal submucosal protuberances and pancreatic diseases. [Methods] 284 patients with submucosal protuberances and pancreatic diseases were examined and treated with EUS. [Results] For the 63 cases of esophagealdiseases, 30 case were diagnosed as leiomyomas, 6 were inflammation, 4 were polyps, 6 were cancer, 1 were cyst, 9 were due to pressure from outside of esophagus. In 169 gastric cases, 67 were inflammation, 40 were gastric stromal tumors （GISTs）, 3 leiomyoma, 14 cancer, 9 polyps, 6 lipoma, 2 ulcer, 2 vein aneurysm in gastric fundus, 1 were ectopic pancreas, 25 were protuberances from outside of stomach wall, and 17 were of no obvious abnormality. 16 duodenal diseases were inflammation in 1 case, polyps in 6 cases, mesenchymal tumor in 3 cases, ectopic pancreas in 1 case, and outside pressure in 1 case. In 36 pancreatic diseases, there were9 cases of pancreatitis, 11 pancreatic cancer, 4 psudopancreatic cyst and 1 cystadenoma. The coincident diagnostic rate between pathology after surgery and endoscopic ultrasonography was 96.3%. Endoscopic band ligation and electric surgery of small mesenchymal tumors and 5 cases were treated by acupuncture injection of pancreas. [Conclusion] EUS has certain value in the diagnosis of gastric submucosal protuberances and pancreatic diseases. It can provide the reference for the choice of treatment.