超声内镜对胃黏膜粗大皱襞性疾病的诊断价值

Diagnostic value of endoscopic ultrasonography for large gastric folds

目的探讨超声内镜在胃黏膜粗大皱襞性疾病诊断中的价值。方法对经常规胃镜及病理检查未能确诊的66例胃黏膜粗大皱襞的患者进行超声内镜检查，分析超声内镜下影像学特征，并将超声内镜的诊断结果与最终确诊结果比较，统计超声内镜诊断的敏感度、特异度以及准确度。结果超声内镜对弥漫浸润型胃癌的诊断敏感度、特异度、准确度分别为92．3％（24／26）、95．1％（39／41）、95．5％（63／66），对浸润型淋巴瘤的诊断敏感度、特异度、准确度分别为92．3％（12／13）、96．1％（49／51）、92．4％（61／66），对良恶性病变的诊断准确度达93．9％（62／66）。良恶性病变在胃壁厚度、固有肌层增厚、胃壁层次是否完整等超声内镜声像特征上差异有统计学意义（P〈0．05）。结论超声内镜对胃黏膜粗大皱襞性疾病具有较好的诊断价值，尤其对弥漫浸润型胃癌、浸润型淋巴瘤诊断准确性高，超声内镜下胃壁厚度、固有肌层是否增厚、胃壁层次是否完整等是鉴别良恶性病变的重要特征。对良性病变的鉴别，仍需其他临床资料。

Objective To evaluate endoscopic ultrasonography （EUS） for diagnosis of large gastric folds. Methods EUS was performed in 66 patients with possible large gastric folds which could not be diag- nosed by conventional gastroscopy. The characteristics of EUS findings were analyzed, and the EUS results were compared with pathological findings to evaluate the sensitivity, specificity and accuracy of EUS. Re- suits The diagnostic sensitivity, specificity and accuracy of EUS for diffused infiltrated gastric cancer were 92. 3% （24/26）, 95.1% （39/41） and 95.5% （63/66）, respectively, and those for gastric lymphoma were 92. 3% （12/13）, 96. 1% （49/51） and 92. 4% （61/66）, respectively. The accuracy in differential diagno- sis of benign and malignant disease was 93.9% （62/66）. There were statistical differences between benign and malignant large gastric folds in characteristics of EUS findings, including width of gastric wall, enlarge- ment of muscularis propria and preservation of gastric layer （P 〈 0. 05 ）. Conclusion EUS is of high accu- racy for diagnosis of large gastric folds, especially for diffused infiltrated gastric cancer and gastric lympho- ma. Such features as width of gastric wall, the enlargement of muscularis propria and the preservation of gas- tric layer are important features for differential diagnosis of benign and malignant lesions.