线阵型超声内镜与微探头超声内镜对十二指肠降部黏膜下肿瘤诊断价值的比较

Comparison of longitudinal-endoscopic ultrasonography and miniprobe endoscopic ultrasonography in diagnosis of submucosal tumors in the descending part of duodenum

目的比较线阵型超声内镜(L-EUS)与微探头超声内镜(MPS)在十二指肠降部黏膜下肿瘤(SMT)中的诊断价值。方法回顾性分析2016年1月-2019年12月81例在该院消化内镜中心应用内镜切除十二指肠降部SMT患者的临床资料,根据术前评估方法分为L-EUS组(n=40例)和MPS组(n=41),以术后病理为诊断金标准,比较两种方法对十二指肠降部SMT的诊断符合率。结果L-EUS组的诊断率符合率为82.5%,MPS组为61.0%,两组比较,差异有统计学意义(P=0.048)。当病变>10.0 mm时,L-EUS组的诊断符合率高于MPS组(84.0%和47.6%,P=0.012);当病变≤10.0 mm时,L-EUS组的诊断符合率虽然高于MPS组(80.0%和75.0%),但两组比较,差异无统计学意义(P>0.05);不论病灶位于壶腹侧或非壶腹侧,两组诊断符合率比较,差异均无统计学意义(P>0.05)。L-EUS组及MPS组发生检查后咽部疼痛的比例分别为7.5%(3/40)及2.4%(1/41),两组比较,差异无统计学意义(P>0.05);两组超声检查过程中均未出现出血和穿孔事件。结论L-EUS对于十二指肠降部SMT的诊断符合率高于MPS,特别是当病变>10.0 mm时,L-EUS的诊断效能更佳。

Objective To compare the diagnostic value of longitudinal-endoscopic ultrasonography(L-EUS)and mini-probe endoscopic ultrasonography(MPS)in submucosal tumors(SMT)of the descending part of the duodenum.Methods The clinical data of 81 patients with submucosal tumors of the descending duodenum who underwent endoscopic resection from January 2016 to December 2019 were collected retrospectively.Preoperative evaluation with L-EUS or MPS was performed in L-EUS group(n=40)and MPS group(n=41).According to the gold standard of postoperative pathology,the diagnostic coincidence rates of the two methods for SMT of the descending duodenum were compared.Results The diagnosis rate of the L-EUS group was 82.5%.The diagnosis rate of the MPS group was 61.0%.There was significant difference between the two groups(P=0.048).Subgroup analysis showed that when the lesion size over 10.0 mm,the diagnosis rate of L-EUS group was better than that of MPS group(84.0%vs 47.6%,P=0.012).When the lesion size was less than 10.0 mm,the diagnostic coincidence rate of the L-EUS group was higher than that of the MPS group(80.0%vs 75.0%,P>0.05),but the difference was not statistically significant.Regardless of whether the lesions were located in the ventral or non-ventral side of the ampulla,there was no significant difference in the coincidence rate of diagnosis between the two groups(P>0.05).The proportion of pharynx pain and discomfort after examination in L-EUS group and MPS group was 7.5%(3/40)and 2.4%(1/41),respectively,and there was no significant difference between the two groups(P>0.05),and there was no adverse event of bleeding and perforation in the process of ultrasound examination in both groups.Conclusion The diagnostic rate of L-EUS in descending SMT of duodenum is higher than that of MPS,especially when the lesion is larger than 10 mm,L-EUS is more effective in diagnosis of duodenal SMT.