超声胃镜对38例原发性胃淋巴瘤的诊断优势和随访价值

Diagnostic superiority of endoscopic ultrasonography in 38 cases of primary gastric lymphoma and its value in follow-up

目的评价超声胃镜对原发性胃淋巴瘤（PGL）的诊断优势和随访价值。方法对2012年1月至2015年6月经普通胃镜检查，活组织检查或手术病理确诊为PGL的38例患者进行超声胃镜检查和靶向深挖活检并动态随访。统计学分析采用t检验和卡方检验。结果超声胃镜联合靶向深挖活检对PGL的诊断敏感度为86.8%（33/38），特异度为83.3%（10/12），诊断准确率为86.0%（43/50）。超声胃镜联合靶向深挖活检的诊断准确率高于普通胃镜[86.0%（43/50）比57.9%（22/38）]，差异有统计学意义（χ^2＝19.4，P〈0.05）。PGL的声像学特征主要表现为局部或弥漫的胃壁增厚，呈均匀或不均匀低回声改变，壁外可有肿大淋巴结。与术后病理分期相比，超声胃镜的肿瘤T、N分期诊断符合率分别为8/8、7/8。H.pylori成功根除组获得完全缓解的平均时间为（3.3±0.8）月，短于H.pylori根除失败组获得的（4.6±0.9）月，差异有统计学意义（t＝4.3，P〈0.05）。结论超声胃镜联合靶向深挖活检对PGL的检出率高，能清晰判断病变浸润深度和范围，指导临床分期和治疗方案的选择；超声胃镜能有效评估PGL的疗效。

ObjectiveTo evaluate the diagnostic superiority of endoscopic ultrasonography （EUS） in primary gastric lymphoma （PGL） and its value in follow-up.MethodsFrom January 2012 to June 2015, 38 patients with suspected PGL under regular gastroendoscopy, biopsy and surgery operation received EUS combined with targeted deep biopsy. T test and chi-square test were performed for statistical analysis.ResultsAmong 50 patients suspected for PGL under regular gastroendoscopy, 38 patients were confirmed pathologically. The sensitivity of EUS examination with targeted deep biopsy in PGL was 86.8% （33/38）, the specificity was 83.3% （10/12） and accuracy was 86.0% （43/50）. The accuracy of EUS examination with deep biopsy was higher than that of regular gastroscopy, and the difference was statistically significant （86.0% （43/50） vs 57.9%（22/38）, χ^2=19.4, P〈0.05）. The main endosonographic characteristics of PGL were partial or diffuse thickening of stomach wall presented with, even or uneven hypoechoic lesions and extramural enlarged lymph nodes. Compared with pathological stage after surgery, the accuracy of T and N stage of EUS was 8/8 and 7/8. The times to achieve complete remission of Helicobacter pylori （H.pylori） eradication group and H. pylori eradication group were （3.3±0.8） months and （4.6±0.9） months, respectively, and the difference between the two groups was statistically significant （t=4.3, P〈0.05）.ConclusionsThe detection rate of EUS combined with targeted deep biopsy is high, which could clearly indicate the depth and extent of lesion invasion and guide clinical stage and selection of therapy. EUS could effectively evaluate efficacy of PGL treatment.