小探头内镜超声诊断上消化道隆起病变643例分析

Analysis of 643 cases with eminence lesions in the upper gastrointestinal tract by miniprobe endoscopic ultrasonography

目的探讨小探头内镜超声检查(mEUS)对上消化道隆起病变的诊断价值。方法对626例患者的643个内镜提示上消化道隆起病变行mEUS检查,分析检查结果。结果643个上消化道隆起性病变中,胃339个,食管218个,十二指肠69个,贲门17个。检出间质瘤和平滑肌(肉)瘤307个(位于黏膜肌层115个,黏膜下层8个和固有肌层184个),异位胰腺62个,脂肪瘤25个,囊肿39个,外压性病变89个,黏液腺瘤2个,血管瘤9个,息肉53个。142个病变取得病理诊断,其中126个与mEUS诊断符合。结论内镜超声检查能清楚显示消化道壁的层次结构,对上消化道隆起病变具有准确的定位作用,并能提示病变的性质;但对间质瘤和平滑肌瘤的鉴别诊断及良恶性的判断有困难。

Objective To evaluate the diagnostic value of the miniprobe endoscopic ultrasonography（mEUS） in the eminence lesions of upper gastrointestinal tract. Methods The 643 cases of upper gastrointestinal eminence lesions were examined by gastroscope within 626 patients then subsequently received mEUS, and the results were analyzed. Results With mEUS, 339 lesions were located in the stomach, 218 cases in the esophagus, 69 cases in the duodenum and 17 cases in the cardia. Of 643 lesions, 307 cases were diagnosed ultrasonographally as gastrointestinal stromal tumor （GIST） , leiomyoma or leiomyosarcoma, 62 etopic pancreas, 25 adipoma, 53 polypus, 39 cyst and 9 angioma, respectively. Compression formed by extra-gastrointestinal lesions or adjacent normal organs were found in 89 cases. In 142 lesions, tissue samples were taken for pathological diagnosis. And 126 of them were consistent with mEUS findings. Conclusion mEUS is an ideal diagnostic modality in distinguishing different layers of the wall of the gastrointestinal tract, and thus of important value in precise localization of lesions beneath the mucosa. Although definite diagnosis still depends on pathology, h is now possible to accurately predict the histological nature in most cases based on such evidence obtained from mEUS as the location and imaging features of the lesion. However, difficulties apparently exist in differentiation of the GIST from the leiomyoma or leiomyosarcoma, and also between malignant and benign in myogenic tumors.