内镜超声在溃疡性结肠炎诊断中的价值初步研究

Diagnostic value of endoscopic ultrasonography for ulcerative colitis

目的探讨内镜超声检查（EUS）和白光内镜、放大内镜在判断溃疡性结肠炎（UC）严重程度中的一致性和互补性。方法确诊的125例UC患者经白光内镜和EUS检查，其中51例行放大内镜检查。根据白光内镜黏膜形态、放大内镜腺开口进行分级，比较各分级下内镜超声测得的肠壁总厚度。结果白光内镜下判断UC炎症程度：重度16例、中度46例、轻度44例、缓解期19例，EUS测得肠壁总厚度分别为（5．903±1．551）mm、（4．673±1．235）mm、（3．756±1．322）mm、（3．464±0．970）mm，除轻度与缓解期比较差异无统计学意义外，其他组别两两比较，差异均有统计学意义（P〈0．05）。放大内镜下根据UC炎症程度分为，绒毛状结构（9例）、典型珊瑚礁状结构（9例）、重度珊瑚礁状结构（8例）、规则腺开口（13例）、上皮微小缺损（6例）、小黄色斑（6例），肠壁总厚度分别为（5．701±0．941）mm、（5．518±0．581）mm、（5．181±0．751）mm、（3．763±0．659）mm、（3．587±0．461）mm和（2．505±0．330）mm，除上皮微小缺损与规则腺开口、典型与重度珊瑚礁状结构和绒毛状结构之间比较，差异无统计学意义外，其他组别两两比较，差异均有统计学意义（P〈0．05）。超声内镜评估黏膜深度，小黄色斑（6／6）、规则腺开口（10／13）多位于黏膜层，而重度珊瑚礁状结构（8／8）病变均浸润至固有肌层。结论EUS对判断UC炎症程度及浸润深度和白光内镜、放大内镜具有一定的一致性，可达到辅助或替代放大内镜判断效果。

Objective To study the consistency and complementarity of endoscopic ultrasonography （EUS） , white light endoscopy （WLE） and magnifying endoscopy （ME） in diagnosis of ulcerative colitis （UC）. Methods We collected 125 cases of UC patients diagnosed by WLE and EUS （including 51 cases of WLE ＋ ME ＋ EUS）. According to UC mucosal morphology under WLE and crypt openings under ME, we divided all the cases into several groups and analyzed intestinal wall thickness （TWT） under EUS in each group. Results According to the results of UC inflammation degree under WLE, all patients were divided into four groups： 16 severe cases, 46 moderate cases, 44 mild, and 19 remission stage. TWT results were （5. 903 ±1.551 ） ram, （4. 673 ± 1. 235 ） mm, （3. 756 ± 1. 322 ） mm and （ 3. 464 ± 0.970） mm, respective- ly. Differences were significant between any two groups （ P 〈 0. 05 ）, except for that between mild and remis- sion groups. According to the results of UC inflammation degree under ME, all patients were divided into six groups ： 9 cases of villous-like structure, 9 cases of typical coral reef-like structure, 8 severe coral reef-like structure, 13 regular crypt opening, 6 epithelial minimal defect and 6 small yellow spot （SYS）. TWT results were （5.701 ±0.941）mm, （5.518±0.581）mm, （5. 181 ±0.751）mm, （3.763±0.659）mm, （3.587± 0. 461 ） mm and （ 2. 505 ± 0. 330 ） mm, respectively. Differences were significant between any two groups（ P 〈 0.05 ） except for those betweerl epithelial minimal defect and regular crypt opening, typical c, oral reef- like structure, villous-like and severe eural reef-like structure. FUS results showed SYS （6/6） and regular crypt opening （ 10/13 ） were mostly located in mucosa, while lesions of severe coral reef-like structure （8/8） invaded the museularis propria. Conclusion EUS shows high consistency with WLE and ME in di- agnosis of UC inflammation degree and invasive depth. It could assist and even substitute ME for evaluation.