内镜超声检查对上消化道隆起性病灶的诊断价值

Diagnostic value of endoscopic ultrasonography in bulge lesions of upper gastrointestinal tract

目的:探讨内镜超声检查(EUS)在上消化道隆起性病灶的诊断与鉴别诊断中的价值。方法:回顾分析2002年1月至2006年6月本院1060例上消化道隆起性病变患者的EUS诊断结果,并与其手术、病理诊断及临床随访结果对照。同时比较EUS与CT检查在黏膜下肿瘤(SMTs)定位及定性诊断中的价值。结果:1060例上消化道隆起性病变中,发生于食管者355例(33.5%),胃618例(58.3%),十二指肠87例(8.2%);EUS诊断为间质瘤260例(24.5%),平滑肌瘤221例(20.8%),脂肪瘤17例(1.6%),腔外压迹221例(20.8%),息肉94例(8.9%),恶性肿瘤96例(9.1%),囊肿57例(5.4%),血管瘤7例(0.7%),炎性皱襞45例(4.2%),静脉曲张21例(2.0%),血肿1例(0.1%)及异位胰腺20例(1.9%)。对EUS诊断SMTs的进一步分析发现,EUS对SMTs性质和来源层次的判断准确率达90.6%和86.9%;与CT比较,EUS在SMTs定位(95.8%比72.9%,P<0.001)和定性(93.8%比64.6%,P<0.001)诊断方面明显优于CT,在良、恶性鉴别诊断方面,CT组与EUS组间差异无统计学意义(91.7%比89.6%,P>0.05)。结论:EUS对上消化道隆起性病灶诊断有较大价值,进一步为制定临床处理方案提供重要的影像学依据。

Objective To assess the value of endoscopic ultrasonography （EUS） in diagnosing bulge lesions of upper gastrointestinal tract. Methods The clinicopathologic data of 1 060 patients with bulge lesions of the upper gastrointestinal tract admitted in Zhongshan Hospital from Jan. 2002 to Jun. 2006 were retrospectively reviewed. The values of EUS and CT in the qualitative and quantitative diagnosis of submucosal tumor （SMT） were compared. Results Of the 1 060 cases of bulge lesion in the upper gastrointestinal tract, 355 cases （33.5%） were located in the esophagus, 618 in the stomach （58.3%）, and 87 in the duodenum （8.2%）. A total of 498 patients were diagnosed as submucosal tumors （SMT） by EUS, including 260 gastrointestinal stromal tumor （GISTs）, 221 leiomyoma and 17 lipoma. Among them, 221 cases （20.8%） were presented as impression from outside, 94 （8.9%） as polyp, 96 （9.1%） as malignant tumor, 57 （5.4%） as cyst, 7 （0.7%） as angioma, 45 （4.2%） as inflammatory plication, 21 （2.0%） as varices, 1 （0.1%） as hematoma and 20 （1.9%） as heterotopic pancreas. In diagnosing submucosal tumors, EUS had an accuracy of 90.6% in judging the quality and 86.9% in judging the source. Compared with CT examination, EUS was significantly more accurate in the diagnosis of location （95.8% vs 72.9%, P〈0.001） and quality （93.8% vs 64.6%, P〈0.001）. However, there was no statistical significance in differentiating benign from malignant tumors （91.7% vs 89.6% ,P〉0.05）. Conclusions EUS is an accurate and safe technology for diagnosing bulge lesions of upper gastrointestinal tract, and could provide important imaging evidence for the clinical management of these lesions.