超声内镜对结直肠黏膜高级别上皮内瘤变术前诊断的应用价值

The value of endoscopic ultrasonography for preoperative diagnosis of patients with colorectal high grade intraepithelial neoplasia

[目的]探讨超声内镜(EUS)对术前结直肠黏膜活检为高级别上皮内瘤变(HGIN)的浸润深度判定的准确性。[方法]选取86例结直肠黏膜活检结果为高级别上皮内瘤变患者,术前行EUS检查初步判断病变浸润深度,根据EUS术前分期的结果指导行黏膜下剥离(ESD)或外科手术治疗。观察术后病理结果,比较EUS对病变浸润深度判断的准确率。[结果]86例患者术前EUS示4例为单纯HGIN,20例考虑为早期结直肠癌,其中有17例行ESD,7例选择行外科手术,21例EUS诊断与术后病理检查病变浸润深度符合,62例EUS诊断为进展期结直肠癌,对其行外科手术治疗,59例EUS诊断与术后病理检查病变浸润深度符合,EUS的对HGIN的诊断特异度、敏感性、阳性预测值、约登指数、一致率分别为87.50%、95.16%、87.59%、82.66%、93.02%。对扁平的病变EUS诊断准确率为95.92%。[结论]结直肠HGIN术前的EUS检查,对病变浸润深度具有较高的准确性,对手术方式的选择具有一定的指导意义。

[Objective]To evaluate the accuracy of EUS on determine the infiltration depth before the operation of colorectal high grade intraepithelial neoplasia（HGIN）.[Methods]Total of 86 patients with colorectal biopsy of HGIN from July 2014 to September 2015 underwent EUS before the treatment were investigated.The patients were suggested with ESD or surgery according to the staging EUS results.The diagnostic accuracies of EUS on the depth of infiltration were verified by the pathological after the treatment.[Results]Of the 86 EUS examinations,4patients were diagnosed HGIN and 20 patients were early colorectal cancer.In the 24 patients,7patients underwent ESD and the other 17 patients received surgical treatments,in which 21patient＇s EUS results were consistent with postoperative pathological results.The other 62 patients which EUS determined advanced colorectal cancer were treated with surgery,in which 59patient＇s EUS results were consistent with postoperative pathological diagnosis.For the diagnosis of EUS on the colorectal HGIN,sensitivity,specificity,accuracy,PPV,Youden index were 87.5%,95.16%,87.59%、82.66%、93.02%respectively.The accuracy of the EUS on determine the infiltration depth in the flat lesion was 95.92%.[Conclusion]EUS has high accuracy in determine the depth of colorectal HGIN lesion and is useful for the choice of treatment.