十二指肠隆起型病变的超声内镜及病理特点

Endoscopic findings and pathological characteristics of duodenal protuberant lesions

目的探讨十二指肠隆起型病变的内镜及组织学特征，加强对十二指肠隆起型病变的认识，提高诊断能力。方法对南京大学医学院附属鼓楼医院内镜中心2005年至2010年检出的869例十二指肠隆起病变的内镜表现和病理特点进行回顾性研究。结果869例隆起病变中，正常组织误诊为病变的有50例（5．8％）。819例真性隆起型病变中，良性781例（95．4％），恶性38例（4．6％）。病理结果以慢性炎性良性病变最多见，为338例，占总数的41．3％，其次为Brunner腺增生155例，占总数的18．9％。恶性病变中腺癌多见，为25例，占总数的3％，另有6例类癌、6例恶性淋巴瘤和1例胚胎性横纹肌肉瘤。十二指肠隆起型病变在内镜下表现多样，有圆形、半球形、指状、分叶状、条索状等，病变大小不一，最大为5cm，以无蒂者（726例，88．6％）多见。超声内镜提示良性病变内部回声均匀，各层结构清楚，恶性病变内部回声不均匀，层次不清，可见侵犯周围组织或淋巴结等。结论十二指肠隆起型病变单靠内镜表现不能明确诊断，超声内镜可有助于提高诊断率，但确诊仍需病理检查。

Objective To explore endoscopic findings and histopathological characteristics of duodenal protuberant lesions in order to improve diagnosis of duodenal protuberant lesions. Methods A total of 869 cases of duodenal protuberant lesions were detected and collected in endoscopy center of Drum Tower Hospital from 2005 to 2010, of which endoscopy findings and pathological characteristics were studied retrospectively. Results Of the 869 case with duodenal protuberance, 50 cases were misdiagnosed as real protuberant lesions. Of the 819 real protuberant lesions, 781 cases （95.40/00） were benign lesions and 38 cases （4. 6%） were malignant lesions. Pathological results indicated that most were chronic inflammation benign lesions （338 cases）, accounted for 41.3%. Secondary were Brunner gland hyperplasia （155 cases）, accounted for 18. 9%. Of malignant lesions, most were adenocarcinoma （25 cases, accounting for 3%）, others were six cases of carcinoid tumor, six cases of malignant lymphoma and one case of emhryonat rhabdomyosarcoma. Endoscopic findings of duodenal protuberant lesions were diverse, such as round, hemispheric, finger-like, lobulated, streak and so on. The diameter of duodenal protuberant lesions varied, the largest was 5 centimeter and most were sessile lesions （726 cases, 88. 6%）. Endoscopic ultrasonic findings indicated that internal echo of benign lesions were even and each layer of structure was clear, while malignant lesions presented uneven internal echo, unclear layer structure and adjacent tissue or lymphoma nodes invasion. Conclusions Duodenal protuberant lesions cannot be confirmed by conventional endoscopic findings. Endoscopic ultrasonography may help to improve the diagnosis. Diagnosis should be confirmed by pathology.