超声内镜对上消化道黏膜下小病变的诊断价值

Value of endoscopic ultrasound in the diagnosis of small subepithelial lesions

目的探讨超声内镜对上消化道直径〈3cm的黏膜下病变的诊断价值。方法回顾性分析2002年1月～2010年8月我院收治的上消化道直径〈3em的黏膜下小病变患者的临床资料。纳入标准：患者经黏膜下肿块剜出术切除病灶，手术后有确切病理诊断；患者在术前曾行超声内镜检查。结果共纳入54例患者，病灶平均大小为（1．06±0．58）cm。黏膜下肿块剜出术的治愈率达82．9％。超声内镜对此类病灶的诊断准确率为74．1％（40／54）；共有14例病例误诊，其中异位胰腺最常见。结论超声内镜对上消化道直径〈3cm的黏膜下病灶具有较高的诊断价值，异位胰腺是最易误诊的病变，黏膜下肿块剜出术可能是治疗上消化道黏膜下小病变的一种有效且安全的方法。

Objective To evaluate the role of endoscopic ultrasound （EUS） in the diagnosis of subepithelial lesions less than 3cm in upper gastrointestinal tract. Methods A retrospective study was performed. Patients with upper gastrointestinal subepithelial lesions less than 3cm at our hospital from 1/ 2002 to 8/2010 were reviewed. Patients who not only had a pathological diagnosis based on complete resection, but also had a EUS examination before resections were included. Results Fifty four patients were included. The average size was （1.06 ±0.58） cm. The curative rate of endoscopic submucosal dissection （ESD） was 82.9%. The accuracy of EUS in diagnosing gastrointestinal subepithelial lesions was 74.1% （40/54）. Fourteen lesions were misdiagnosed. Aberrant pancreas was the most common misdiagnosed lesion. COnclusion EUS is valuable in the diagnosis of subepithelial lesions less than 3cm. Aberrant pancreas is the most common misdiagnosed lesion. Endoscopic resection may be a useful and safe method to remove the small subepithelial lesions in upper gastrointestinal tract.