超声内镜及其引导下的细针穿刺在食管结核诊断中的应用

EUS and EUS-FNA for diagnosis of esophageal tuberculosis

目的:总结食管结核的超声内镜声像图特征,评价超声内镜及引导下的细针穿刺(endoscopic ultrasonography guided fine needle aspiration,EUS-FNA)在食管结核诊断与鉴别诊断中的作用.方法:回顾分析我院11例食管结核患者的临床表现、超声内镜声像图特征与EUS-FNA穿刺结果.结果:11例诊断为食管结核的患者,8例病灶位于食管中段,3例位于食管上段;7例为隆起型病灶,4例为溃疡型病灶;超声内镜表现为食管壁层次不清或消失,部分为食管壁内低回声占位,部分为壁外低回声占位侵及食管壁,内部回声不均,见强回声光斑,多伴有纵隔淋巴结肿大,且其内见散在钙化斑;7例行EUSFNA穿刺,2例为干酪样坏死物,2例病理考虑结核,3例未见异型细胞.结论:超声内镜可显示病灶形态及其与食管壁的关系、病灶内部回声特征、壁外淋巴结情况,结合EUS-FNA穿刺细胞学与病理学检查,在食管结核的诊断和鉴别中具有重要价值.

AIM： To summarize the endoscopic ultrasonog- raphy （EUS） characteristics of esophageal tuber- culosis and evaluate the role of EUS and EUS guided fine needle aspiration （EUS-FNA） in the diagnosis and differential diagnosis of esopha- geal tuberculosis. METHODS： The clinical data, EUS and EUS- FNA data for 11 patients with esophageal tuber- culosis were collected and analyzed retrospec- tively. RESULTS： Eight lesions were found in the mid- dle part of the esophagus and 3 in the upper part.The lesions demonstrated as protrusion in 7 cases and ulceration in 4 cases. The layers of the esoph- ageal wall were unclear or disappeared in some cases, and in some patients low echo occupying lesions inside or outside the esophageal wall were showed by EUS. The internal echo of the lesions was heterogeneous, and strong echo spots could be observed. In most cases, enlarged mediastinal lymph nodes were observed. EUS-FNA was used to take biopsy specimens in 7 cases： caseouse ne- crosis was found in 2 cases; 3 biopsy specimens suggested tuberculosis; no cancer cells were ob- served in 2 biopsy specimens. CONCLUSION： EUS can not only show the morphology and internal echo of the lesions, as well as the relationship between the lesions and esophageal wall, but also allow to observe the lymph nodes outside the esophageal wall. Bi- opsy specimens can be taken by EUS-FNA. EUS and EUS-FNA have high value in the diagnosis of esophageal tuberculosis.