152例消化道隆起性病变超声内镜诊断分析

Analysis of endoscopic ultrasonography on 152 protrusion lesions of gastrointestinal tract

目的探讨超声内镜(endoscopic ultrasonography, EUS)对消化道隆起性病变诊断的意义。方法回顾性分析2014年1月至2016年12月就诊于空军军医大学西京消化病医院的消化道隆起性病变152例患者的临床资料。所有患者行普通内镜检查、胸腹部CT及EUS检查,观察其病变的部位、大小、起源层次、回声表现等,结合内镜切除后病理结果,分析普通内镜、CT与EUS检查与病理结果的符合率以及EUS判断消化道隆起性病变的准确率。结果 152例患者中平滑肌瘤最多(59例,占38.8%),且多位于食管(55例,占所有平滑肌瘤的93.2%)。124例患者EUS结果与病理诊断一致,符合率为81.6%,EUS诊断消化道黏膜隆起性病变符合率显著高于消化道黏膜下隆起性病变,差异有统计学意义(93.9%vs. 72.1%,P <0.05)。EUS诊断消化道隆起性病变的符合率显著高于普通内镜(51.3%)和胸腹部CT(45.4%),差异均有统计学意义(P <0.05)。EUS对间质瘤误诊率较高(68.2%),对罕见黏膜下病变如神经鞘瘤及血管球瘤漏诊率高(均为100%)。结论消化道隆起性病变以平滑肌瘤最常见,且好发于食管。EUS检查对消化道隆起性病变具有较高的诊断价值,优于普通内镜及胸腹部CT检查,但对于间质瘤及少见的黏膜下病变的诊断还存在不足。

Objective To investigate the value of diagnosis of endoscopic ultrasonography for protrusion lesions of gastrointestinal tract. Methods One hundred and fifty-two cases of patients with gastrointestinal lesions from January 2014 to December 2016 in Xijing Hospital of Digestive Disease were collected. All patients underwent electronic gastroscopy, CT scan and EUS detection. The postoperative pathological results were taken as golden standard. The diagnostic accordance rate was compared between EUS and electronic gastroscopy, and EUS and CT scan. Results Among the 152 cases, the common lesion was leiomyoma(38.8%), which was mainly located in esophagus(93.2%). One hundred and twenty-four of the 152 cases whose diagnosis of EUS were consistent with that of postoperative pathological and the total coincidence rate was 81.6%. The diagnostic accordance rate of EUS in mucosa lesion was higher than that in submucosal lesion(93.9% vs. 72.1%, P < 0.05). The diagnostic accordance rate of EUS in protrusion lesions of gastrointestinal tract was higher than electronic gastroscopy(51.3%) and CT scan(45.4%), the differences were statistically significant. In stromal tumors, the misdiagnosis rate of EUS was high(68.2%). And in schwannoma and glomangioma, the misdiagnosis rate of EUS were both high(100%). Conclusions The common protrusion lesion in gastrointestinal tract is esophagus leiomyoma. EUS achieves a higher diagnostic accuracy for protrusion lesions of gastrointestinal tract and is better than electronic gastroscopy and CT scan. But EUS still has dignosis deficiency in stromal tumor and some rare submucosal lesions.