超声内镜对上消化道黏膜下隆起性病变的诊断价值

The diagnostic value and misdiagnosis analysis of endoscopic ultrasonography in diagnosis of submucosal lesions of upper digestive tract

目的:探讨超声内镜对上消化道黏膜下隆起性病变的诊断价值,并对误诊的病例进行分析,以期提高超声内镜对上消化道黏膜下隆起性病变的诊断准确率。方法:对内镜检查发现的1 364例上消化道黏膜下隆起性病变进行超声内镜检查,超声结果与术后病理结果进行比较,对误诊较多的病例回顾分析其超声图像特征,探讨误诊原因。结果:病理与超声结果符合的病例有106例,与超声结果不符合的有35例,诊断准确率达75.18%(106/141),明显高于胃镜的诊断准确率33.33%(47/141),两者比较差异有统计学意义(P<0.01);超声下,回声不均匀、起源于肌层的黏膜下肿瘤,间质瘤的可能性比平滑肌瘤的可能性大(P<0.01);对病灶位于胃窦尤其是胃窦大弯,并且超声图像示回声不均匀、边界欠清楚、形状不规则、起源于肌层的胃黏膜隆起性病变,除考虑胃间质瘤外还要排除是否存在胃异位胰腺的可能。结论:超声内镜对上消化道黏膜下隆起性病变具有良好的诊断价值,但对平滑肌瘤与间质瘤的鉴别较困难;对起源于肌层的形态不典型的胃异位胰腺,有时与胃间质瘤难以鉴别。

Objective： To explore the diagnestic value of endoscopic ultrasonography （EUS） in diagnosis of submucosal lesions of upper digestive tract and investigate reasons of misdiagnosls. Methods： A total ot 1,304 cases with submucosal lesions of upper digestive tract examined with EUS were included in this retrospective study. Diagnoses by EUS were compared with those by postoperative pathological examination. We further selected the misdiagnosed cases with a high possibility of misdiagnosis were further retrospectively analyzed, and then the reasons of misdiagnosis were explored. Results： Diagnoses of 106 cases by EUS were consistent with those by pathological examination, the other 35 cases did not agree with the pathology. The accuracy of diagnosis with EUS for submucosal lesions in upper digestive tract was up to 75.18% （106/141）, which was much superior to that of gastroscopy （33.33%, 47/141, P〈0.01）. A tumor originating from muscular layer with heterogeneous echopattern was seen more frequently in stromal tumor than that in the leiomyoma （P〈0.01）. A possibility of gastric heterotopic pancreas besides excluding malignant gastric stromal tumor should be consid- ered if a protuberant lesion originating from muscular layer was detected in gastric antrum especially in greater curvature with heterogeneous echopattern, irregular shape and unclear border. Conclusion： EUS is quite a valuable means for the diagnosis of upper gastrointestinal submucosal lesions, however, it is still limited for differentiatial diagnosis among leiomyomas, stromal tumors and schwannomas. Sometimes, it is also difficult to differentiate gastric stromal tumors from untypical gastric heterotopic pancreas.