线阵式超声内镜引导下细针针吸活组织检查对粘膜下病变的诊断价值

Evaluation of linear scanning endoscopic ultrasonography guided fine needle aspiration biopsy of submucosal lesions

目的通过内镜超声检查（ EUS）结合细针针吸活组织检查 (简称活检 )来确定粘膜下病变的起源和性质，并评价这种方法对粘膜下病变诊断的价值。方法经胃镜发现 28例食管、胃实质性粘膜下病变的患者，对他们进行超声内镜检查，以明确其来源的层次、病变的位置，观察有无淋巴结转移。排除腔外正常组织压迫，在超声内镜引导下对病变行细针针吸活检。结果 28例患者中 2例经 EUS证实为腔外正常组织压迫，余 26例患者均行 EUS引导下的细针针吸活检。 3例患者穿刺取材失败。 23例患者经细胞学或组织学分析显示 4例恶性肿瘤（淋巴瘤 2例，平滑肌肉瘤 2例）及 19例良性病变（平滑肌瘤 18例，脂肪瘤 1例）。全部 20例经手术、 1例经内镜电切及 7例经临床随访验证。结论 EUS结合细针穿刺活检是诊断粘膜下病变安全、有效的方法。

Objective To determine the value of EUS-guided fine needle aspiration biopsy（ FNAB） for the diagnosis of submucosal lesions. Methods We found 28 patients with upper gastrointestinal tract solid submucosal lesions by endoscopies. EUS was performed to assess the lesions arised from the specific layer of the wall and the lymph node metastasis. After excluding extrinsic normal tissues compressing the gastrointestinal tract, EUS guided FNAB were carried out. Results Among these patients, two were extrinsic normal tissues compressing the gastrointestinal tract and all other 26 patients were examined by EUS guided FNAB. EUS-guided FNAB failed in only 3 patients. Among the other 23 patients, cytology demonstrated malignant tumors in 4 patients (lymphoma, n=2; leiomyosarcoma, n=2) and benign lesions in 19 patients (leiomyoma, n=1; lipoma, n=1). The results of EUS-guided FNAB were validated by surgery (n=20), endoscopic treatment (n=1) or clinical follow-up (n=7). Conclusion EUS guided FNAB is a safe and accurate method for diagnosis of submucosal lesions.