37例直径大于1.0cm十二指肠隆起性病变的临床、内镜、超声及病理分析

Evaluation of Clinical,Endoscopic,Endoscopic Ultrasonograph Pathological in 37 Patients with Duodenal Protrude lesions Larger than >1.0cm

目的探讨十二指肠隆起性病变的临床,内镜、超声及病理特点。方法对37例十二指肠隆起性病变患者均采用Fujion EG-450型胃镜,Olympus UM-2R超声微探头检查及治疗,超声频率为7.5MHz～12MHz,高频电发生器为ERBE-200型。结果常规内镜发现隆起性病变位于十二指肠球部23例,降部14例。常规内镜诊断为十二指肠腺瘤性息肉14例,增生性息肉4例,腺癌2例。17例超声内镜诊断间质瘤11例,黏膜下囊肿4例,脂肪瘤2例。其中有24例病变术后病理诊断为腺瘤性息肉14例,增生性息肉4例,脂肪瘤2例,良性间质瘤3例,平滑肌瘤1例。7例疑为恶性间质瘤(术后确诊为恶性间质瘤4例,良性间质瘤2例,1例不明)。治疗有24例病变行高频电凝切除术,术后处理按我科常规进行;7例超声检查疑为恶性间质瘤,其中6例由外科手术治疗,1例保守观察;4例囊肿采用经内镜下囊肿套扎术治疗;2例十二指肠腺癌采取保守支持对症治疗。对上述所有病例仍在动态观察中。结论对于范围大于1.0cm的十二指肠隆起性病变常规内镜及病理检查、内镜超声检查对隆起性病变的诊断均具有重要价值。

Objective To evaluate the features of clinical, endoscopic, endoscopic ultrasonograph and pathological of duodenal protrude lesions. Methods 37 patients with duodenal protrude lesion all were examind and treated with electronic endoseope , some were examed with endoscopic uhrasonograph （EUS） . Results In endoscope , 23 protrude lesions were located in duodenal ampulla, 14 in descending part . Among these 14 cases were diagnosed duodenal adenomatous polyps, 4 were hyperplastic polyp, 2 were adenocarcinoma. For 17 cases , 11 cases were diagnosed stromal tumor in EUS, 4 were submucous cyst, 2 were lipoma. 24 cases pathological result displayed that 14 cases were adenomatous polyps after operation, 4 were hy- perplastic polyps, 2 were lipoma, 3 were benign stromal tumor, 1 was leiomyoma. 7 cases were suspected malignant stromal tumor （4 cases were malignant stromal tumors, 2were benign stromal tumor, 1 case unknown）. Treatment There were 24 lesions were treated by high frequency electric resection. Among the 7 cases which were suspected malignant stromal tumors, 6 were treated by surgery, 1 was conservatively observed. 4 cases of cysts using the hematoma loop ligation treatment in endoscopy, 2 eases of duodenal adenocarcinoma accepted conservative support symptomatic treatment. All cases were still under dynamic observation. Conclusion The examination of electronic endoscope, endoscopic uhrasonograph and pathology are of great value for duodenal elevated lesions with diameter 〉 1.0 cm.