上消化道上皮下病变超声内镜影像学结果分析

Analysis of the results of EUS examination on upper gastrointestinal subepithelial lesions

目的通过对上消化道上皮下病变行超声内镜(EUS)检查,探讨其EUS影像学特征并进行评估,进一步提高EUS对上消化道上皮下病变的诊断价值,为临床诊疗策略提供依据。方法回顾性分析2016年1月至2017年1月经天津市人民医院内镜诊疗中心行普通胃镜检查提示的412例上消化道隆起性病变(包括食道、胃及十二指肠),对其进行总体评估,并选取其中经内镜下切除并经病理及免疫组化确诊的184例患者,分析其具体分布情况及EUS下影像学特征。结果上消化道上皮下病变,按部位分类以胃部病变最多见,其中胃部病变以胃底及贲门胃底侧最常见,其次为食道及十二指肠病变;按病种分类以间质瘤(GISTs)最常见,其中GISTs以胃底最多见;其次为平滑肌瘤,以食道最多见;按EUS层次分类以固有肌层病变为主,主要位于胃底及贲门胃底侧,固有肌层病变以GISTs为主;其次为黏膜下层病变,主要位于十二指肠及食道,以囊肿及脂肪瘤最常见;黏膜肌层病变,主要位于食道部,以平滑肌瘤最常见。结论各种上皮下病变在内镜及EUS下均有一定特点,EUS对上消化道上皮下病变的大小、起源、回声特点,尤其是较小或早期的上皮下病变均有一定的诊断价值,对其治疗方式的选择及随访方案有着指导作用。

Objective To investigate and evaluate the features of EUS examination results of the upper gastrointestinal subepithelial lesions by endoscopic ultrasonography（ EUS）,so as to further improve the diagnostic value of EUS on the subepithelial lesion of upper gastrointestinal tract and to provide evidence for clinical diagnosis and treatment. Methods Four hundred and twelve patients with protruded lesions in upper gastrointestinal tract,including esophagus,stomach and duodenum,diagnosed by gastroscopy,were retrospectively analyzed in this study from January 2016 to January 2017 in Tianjin Union Medicine Center,and the overall assessment was performed. One hundred and eighty-four lesions diagnosed by pathology and immunohistochemistry after endoscopic resection were selected for analyzing its specific distribution of location and the imaging features under EUS. Results The subepithelial lesions of the upper gastrointestinal tract were most commonly found in the stomach,especially fundus and cardia close to fundus of stomach,while less in esophagus and duodenum. Categorized by pathological diagnosis,gastrointestinal stromal tumors（ GISTs） were the most common lesions,most of which was found at fundus. Less common subepithelial lesion was leiomyoma,most of which was found at esophagus. Categorized by location of EUS,lesions originating from the muscularis propria layer were the most common,mainly GISTs,at gastric fundus and cardia,and the second common ones were from submucosal layer,mainly lipomyoma and cyst,at esophagus and duodenum. The third common were from mucosal propria layer,mainly leiomyoma,at esophagus.Conclusions All kinds of subepithelial lesions have certain characteristics under the examination of endoscopy and EUS. EUS has certain diagnostic value on characteristics of the size,origination and echo of upper gastrointestinal subepithelial lesions,especially for some smaller or subepithelial lesions at early stage,playing a guiding role for choosing appropriate treatment method and follow-up scheme.