超声内镜对上消化道黏膜下肿瘤诊断与鉴别诊断的价值

Endoscopic ultrasonography in diagnosis and differential diagnosis of upper digestive tract submucosal tumors

目的 :评价超声内镜 (endoscopicultrasonography ,EUS)对上消化道黏膜下肿瘤诊断与鉴别诊断的价值。 方法 :通过对 97例上消化道黏膜下肿瘤及 5 1例其他隆起性病变进行EUS检查 ,并与内镜活检、切除和手术病理进行比较。 结果 :上消化道黏膜下肿瘤种类的分布有一定规律 ,其中间质细胞瘤最为常见 ,本组占 35 .81 % (5 3/1 4 8) ;EUS对本组的总诊断符合率达91 .2 2 % (1 35 /1 4 8) ;各种黏膜下肿瘤的声像图具有一定的特征。间质细胞瘤的声像图特征为低回声 ,呈梭形或椭圆形 ,病灶边界清楚、包膜光滑、回声均匀。恶性间质细胞瘤边界不清 ,包膜完整性差 ,回声不均 ,常有断裂征 ;与间质细胞瘤难以鉴别的神经源性肿瘤与颗粒细胞瘤的声像图呈低回声。与胃镜、钡餐造影、CT等相比 ,EUS更易确定病变的性质。 结论

Objective:To examine the clinical value of endoscopic ultrasonography (EUS) in the diagnosis and the differential diagnosis of upper digestive tract submucosal tumors (SMTs). Methods: Totally 97 cases of SMTs and 51 cases of other protuberent lesions in upper digestive tract were examined by EUS (Olympus UM 230P or UM 200),and the histological results were compared with those by endoscopic biopsy, endoscopic resection and surgery. Results: Distribution of various SMTs had some regularity. Interstitial cell tumors were the most frequently encountered ones. Of the 148 patients in our group, 53 had interstitial cell tumors. The accuracy of diagnosis with EUS was 91.22%. There were some characteristics of echo texture in various SMTs. Interstitial cell tumors were the most common SMTs with uniform hypoecho, shuttle or oval shape and distinct membrane; while malignant interstitial cell tumors had odds hypoecho, unclear margin and rupture signs. Neurogenic and granular cell tumors, which were difficult to be distinguished from interstitial cell tumor, also presented hypoecho. Campared with endoscopy, computerized tomography(CT) and barium contrast of upper digestive tract, EUS is capable of determing the property of lesions.Conclusion: EUS is a more valuable method in the diagnosis and the differential diagnosis of SMTs in upper digestive tract. [