26例直肠神经内分泌肿瘤患者EUS征象分析及临床价值

26 signs and their clinical value in diagnosis of rectal neuroendocrine neoplasms

目的分析26例直肠神经内分泌肿瘤患者内镜超声(EUS)征象并探讨其临床诊断价值。方法回顾性分析2014年3月至2016年2月我院消化内科收治的26例直肠神经内分泌肿瘤患者及同期来我院就诊的25例直肠其它黏膜病变患者的临床资料,其中26例直肠神经内分泌肿瘤患者为观察组,25例直肠其它黏膜下病变患者为对照组,分析观察组患者临床表现、两组EUS诊断结果及EUS特征比较。结果直肠神经内分泌肿瘤患者经EUS检查发现临床表现主要有:便秘,排便次数增加,黏液脓血便,下腹部隐痛等;部分患者无明显症状。内镜超声诊断直肠神经内分泌肿瘤的敏感性为96.15%(25/26),特异性80.00%(20/25),阳性预测值83.33%(25/30),阴性预测值95.24%(20/21),准确度为89.98%,约登指数为0.75。患者EUS特征比较发现直肠神经内分泌肿瘤病灶区灰度值较直肠其它黏膜病变病灶区显著大(P<0.05)。结论通过EUS对直肠神经内分泌肿瘤与直肠其它黏膜病变的诊断,两者病理结构差异较大,EUS对直肠神经内分泌肿瘤的诊断具有较显著的临床价值。

Objective To analyze the endoscopic ultrasound （EUS） signs of 26 patients with rectal neuroen- docrine neoplasms, and to explore their clinical diagnostic value. Methods The clinical data of 26 cases of patients with rectal neuroendocrine neoplasms （observation group） who were admitted in the department of gastroenterology in our hospital from March 2014 to February 2016 and 25 patients with other rectal mucosal lesions （control group） who were admitted in the same period were analyzed retrospectively. The clinical manifestations of the observation group were analyzed. The results of EUS diagnosis and EUS signs were compared between the two groups. Results The main clinical manifestations of patients with rectal neuroendocrine neoplasms found by EUS examination included constipation, increased frequency of defecation, mucopurulent bloody stool and lower abdominal pain, etc.. Some patients had no obvious symptoms. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Youden index of EUS in the diagnosis of rectal neuroendocrine neoplasms were 96.15% （25 / 26）, 80.00% （20 / 25）, 83.33% （25 / 30）, 95.24% （20 / 21）, 89.98% and 0.75, respectively. The percentage of rectal neuroendocrine neoplasms in rectal submucosal lesions was 49.02% （25/51 ）. The comparison of EUS findings found that the gray values of rectal neuroendocrine neoplasms were significantly higher than those of other rectal mucosal lesions （P 〈 0.05）. Conclusion The EUS diagnosis of rectal neuroendocrine neoplasms and other rectal mueosal lesions finds that there are significant difference in pathological structure between the two. EUS is of significant clinical value in the diagnosis of rectal neuroendocrine neoplasms.