超声检查对胃间叶源性肿瘤并发溃疡的诊断价值

Value of ultrasound in the diagnosis of gastric mesonchymal tumor with complicated ulcer

目的探讨二维超声、彩色多普勒血流成像、动态三维表面成像对胃间叶源性肿瘤(GMT)并发溃疡的诊断价值。方法采用饮水胃充盈法,利用二维超声、彩色多普勒血流成像、动态三维表面成像观察12例GMT(包括间质瘤8例、平滑肌类肿瘤4例)并发溃疡患者(GMT溃疡组)和33例(包括间质瘤25例、平滑肌类肿瘤6例、脂肪瘤1例、神经鞘瘤1例)不合并溃疡的GMT患者(GMT对照组)。所有病例均先行超声检查并经内镜活检或手术病理和免疫组化证实。结果 12例GMT合并溃疡患者均以孤立膨胀性团块并表面缺口为直接超声征象,其团块最大径为(7.2±5.4)cm,超声检出率100%;溃疡深度为(1.9±1.2)cm。GMT对照组团块最大径为(3.2±1.5)cm,与GMT溃疡组比较差异有统计学意义(t=2.933,P=0.005);间质瘤、平滑肌瘤团块及溃疡大小、形态差异无统计学意义。GMT合并溃疡超声声像图特征:(1)仅见于腔内型或壁内-外型团块;(2)团块直径多数>5.0cm;(3)溃疡多见于团块胃腔面(即黏膜覆盖区)的头端近中部或顶部区;(4)溃疡形态为"火山口"样、"弹坑"样或"窑洞"样。结论饮水胃充盈后,采用二维超声、彩色多普勒血流成像、动态三维表面成像,不仅能对GMT作出大体判断,而且能观察团块表面溃疡的形态及与囊性变相通的情况,可弥补内镜及CT的不足。

Objective To evaluate the diagnostic value of gastric mesonchymal tumor（GMT） with complicated ulcer through 2-dimension ultrasound （2DUS）, color Doppler flow imaging （CDFI） , and dynamic 3-dimension surface imaging（4DUS）. Methods Twelve cases of GMT（8 cases of stromal tumor,4 cases of liomyoma） were observed by 2DUS, CDFI and 4DUS through water filling stomach. Meanwhile,33 cases of GMT without complicated ulcer（25 cases of liomyoma,6 cases of st,＇omal tumor, 1 case of lipoma, 1 case of neurinoma） were contrasted. All the cases had been performed ultrasonic examination previously and confirmed by endoscope or operation pathology and immunity examination. Results Twelve cases of GMT with complicated ulcer showed isolate expanded balls and the direct signs were surface gaps with the average maximal diameter[ （7.2 ± 5.4）cm], and the ultrasonic detectable rate was 100% ,while the average ulcer depth was （ 1.9 ± 1.2） cm. The average maxinkal diameter of the balls of the contrast group was （3.2 ± 1.5 ） cm, which had statistical differences from the complicated ulcer group （ t = 2. 933, P = 0. 005 ）. The balls of stromal tumor and liomyoma,the size of complicated ulcer and different forms had no statistical differences. The features of GMT with complicated ulcer were as follows ： （ 1 ） It existed only in intramural or extramural balls ; （2） The diameters of many balls were 〉 5.0 cm ; （ 3 ） The ulcers appeared in the top, middle of the nmcosa-covered balls; （4）The figures were volcano-mouth-shaped,crater-shaped or cave-shaped. Conclusions After water filling of the stomach,2DUS, CDFI, and 4DUS not only can make correct judgement, but also observe the appearance of the surface ulcer of the balls and the cystic change. This approach is simple and aceurate means which can make up for endoscope and CT.