超声内镜在消化系黏膜下病变中的应用

Endoscopic ultrasonography for gastrointestinal submucosal lesions

随着内镜技术的发展,消化系黏膜下病变(submucosal lesions,SMLs)在临床上越来越多的被发现.超声内镜(endoscopic ultrasonography,EUS)既往被认为是消化系S M L s诊断的一项可靠的技术.但随着E U S在临床的广泛应用和内镜下大黏膜剥离(endoscopic submucosal dissection,ESD)技术深入开展,现对EUS诊断SMLs提出了新的问题:EUS判断SMLs的准确性如何,能否鉴别各种SMLs的性质,对病变侵袭层次的定位及对ESD等手术的术前判断价值如何等.本文重点就这些问题总结了近10年来国内外文献相关研究报道,从EUS对消化系SMLs性质的判断、诊断的准确性、良恶性的鉴别、EUS引导下细针穿刺技术(EUS-guided fine needle aspiration,EUS-FNA)、EUS的随访价值等方面对EUS在消化系SMLs中的应用作一综述.

Advances in endoscopic imaging technology have led to the detection of more cases of gas- trointestinal submucosal lesions （SMLs）. Endo- scopic ultrasonography （EUS） was previously known as the best imaging procedure to char- acterize SMLs. However, the progress of endo- scopic submucosal dissection （ESD） has raised some new questions concerning the role of EUS in the diagnosis of SMLs. What is the diagnostic accuracy of EUS for SMLs？ How is the nature of SMLs determined？ How is the layer of origin identified？ What is the preoperative value of EUS for ESD？ In this review, we will discuss the endosonographic features of SMLs, the diagnos- tic accuracy of EUS, the ability of EUS to distin- guish benign and malignant SMLs, the value of EUS-guided fine-needle aspiration （FNA）, and the value of EUS in clinical surveillance.